Preamble

The House met at half-past Eleven o'clock

PRAYERS

MADAM SPEAKER in the Chair]

Oral Answers to Questions — TRADE AND INDUSTRY

The Secretary of State was asked—

Milk Marque

Mr. David Heath: When he will publish the recommendations of the Monopolies and Mergers Commission in respect of Milk Marque; and if he will make a statement. [82356]

The Secretary of State for Trade and Industry (Mr. Stephen Byers): The report from the Monopolies and Mergers Commission on the supply of raw cows' milk in Great Britain has now been received. I expect to publish it before the House rises for the summer recess.

Mr. Heath: I am grateful to the Secretary of State for that answer, but the delay and uncertainty caused by his inability to publish the report are having the gravest consequences for the dairy industry. Somerset dairy farmers in my constituency have already suffered enough this year. Will the right hon. Gentleman deny the rumour now sweeping the industry and give an absolute assurance that the report has not been delayed for political convenience connected with the Welsh elections, and that it will not be delayed until the summer recess? We need an answer now.

Mr. Byers: The report was not received until the beginning of March. It is receiving detailed consideration and will be published before the summer recess. The timing is not for political reasons, but to ensure that full and proper consideration is given to the recommendations.

Mr. John Bercow: I am afraid that the Secretary of State's response to the hon. Member for Somerton and Frome (Mr. Heath) was not good enough. Given that dairy farmers are suffering their worst crisis for 60 years, with average incomes having fallen by more than 60 per cent. in the past two years alone, and as the Government's botched common agricultural policy negotiations in Brussels mean that Britain's milk producers cannot expect to receive any increase in quota until 2006, does the right hon. Gentleman not understand the keen interest and anxiety with which the MMC's verdict on Milk Marque is awaited by dairy farmers in my

constituency? He has had the MMC report for more than two months—70 days, to be exact. When will he stop dithering and announce a decision?

Mr. Byers: There is no dithering. The report is being considered and we shall publish it as soon as it is practical to do so. That will be before the summer recess.

Millennium Compliance

Mr. David Atkinson: If he will make a statement on progress with the millennium readiness of computer systems in the private sector. [82359]

The Minister for Small Firms, Trade and Industry (Mr. Michael Wills): On 4 March, Action 2000 published its fourth report on its state of the nation survey of millennium preparedness among United Kingdom businesses, which showed a continual improvement in terms of the readiness of their systems to cope with the end of century date change.

Mr. Atkinson: Does the Minister agree that, without total disclosure of their millennium compliance by all computer-dependent businesses, no one can say that the British economy will be safe after the end of this year? As the Government missed—indeed, objected tothe two opportunities that I offered them through my private Member's Bills to provide for such disclosure, can the Minister assure the House that British business will be millennium ready?

Mr. Wills: We are well aware of the keen interest that the hon. Gentleman has taken in the problem and we are grateful to him for it; he shows a commendable public spirit. However, we do not think that legislation such as he has suggested is necessary. We must be careful not to create bureaucratic requirements for companies to check things unnecessarily. Companies are subject to many pressures, of which the century date change is one, on their limited resources.
However, may I offer the hon. Gentleman some reassurance about the state of preparedness, especially in connection with the crucial infrastructure of this country? As he will be aware, the national infrastructure forum gave us the latest information from Action 2000 on 21 April, and it showed a considerable degree of readiness. He will be familiar with the colour coding of blue, amber and red. Blue indicates no identifiable risk of material disruption, and, if I may, briefly, with your indulgence, Madam Speaker, refer to the fact that in the—

Madam Speaker: Order. Perhaps that could be the subject of an Adjournment debate.

Mr. Wills: I am sorry, Madam Speaker.
I assure the hon. Gentleman that there is a high degree of readiness, and I am confident that there is no significant risk of disruption.

Exporters

Sir Sydney Chapman: What assessment he has made of the prospects for exporters in the present financial year. [82360]

The Secretary of State for Trade and Industry (Mr. Stephen Byers): The Treasury and independent forecasters expect the volume of exports of goods and services to grow both this year and next.

Sir Sydney Chapman: As unemployment is expected to rise over the next two years, and, contrary to what the Secretary of State has just said, the Confederation of British Industry forecasts that economic growth will be sharply down this year, does the right hon. Gentleman agree with the Financial Times editorial yesterday, which advocated a weaker currency? What representations is he making to his right hon. Friend the Chancellor to reduce interest rates—although, of course, the Chancellor no longer has the power to do that? Does the Secretary of State not bitterly regret that fact?

Mr. Byers: The Government made it clear that we would not play short-term party politics with interest rates. We have given independence to the Monetary Policy Committee of the Bank of England, and we will support decisions taken by the Bank on interest rates. It is largely because of that independence that we now have the lowest long-term interest rates for 40 years, which is good news for exporters and for the economy in general.

Mr. Geraint Davies: Does my right hon. Friend agree that today's historic change in Britain's constitution will herald a new era for exporters in which each region can consolidate in partnership to export and compete in the global marketplace? The new regional development agencies and the Welsh Development Agency can help in that. Does he also agree, first, that the political fallout will precipitate a change in the Opposition leadership, which will become more Euro-friendly and therefore build confidence in our key export markets; and, secondly, that today is a great day for British exports?

Mr. Byers: I do not intend to attack the Conservative Opposition, because they are very good at doing that for themselves. It will be an historic day, with the votes being cast in Wales and Scotland. I have no doubt that when people cast their votes they will reflect on the success of this Government, with some 400,000 new jobs having been created since we took office. Some 3,000 new jobs were announced in Scotland during the election campaign and 6,500 jobs have been created in south Wales, with the Baglan bay energy project. For the two years this Government have been in office, a job has been created every two minutes. We are proud of that and we are confident that, when people cast their votes today, they will acknowledge the Government's success.

Dr. Vincent Cable: Does the Minister accept the estimate of the influential National Institute of Economic and Social Research this week that the pound is currently 15 to 16 per cent. overvalued in terms of the underlying competitiveness of the British economy? If he does not agree, will he explain why?

Mr. Byers: What I do know is that, if hon. Members consider sterling in terms of its appreciation against other

currencies, they will see that its current position bears no comparison with the dramatic increase that we saw before the 1997 general election. Two thirds of the drop in exports last year was not in exports to those countries where our currency has appreciated in value but because of the decline in the south-east Asian markets. That is where the problem arose.

Mr. Jeffrey Donaldson: The Secretary of State will be aware that one of the important components in the competitiveness of British industry in exporting goods is the cost of transporting those goods. In Northern Ireland, we are heavily reliant on the road haulage industry for the export of goods from our part of the United Kingdom. Is he aware that £100 will purchase 129 litres of diesel in Northern Ireland, but 227 litres in the Irish Republic; and that the additional burden placed on road hauliers by the Chancellor of the Exchequer through increases in excise duties is making it much more difficult to export goods from Northern Ireland, compared with our competitors in the Irish Republic? Will the Secretary of State make representations to the Chancellor on behalf of the road haulage industry to see whether that burden can be eased in any way?

Mr. Byers: There are many companies in Northern Ireland that are doing well in exports and I was pleased to present the Northern Ireland exporter of the year awards last year. I hear the concerns expressed by the hon. Gentleman. He will be aware that my colleague the Minister of Transport has set up a group with the industry to consider the problems it faces, and I hope that the group will produce some recommendations that will address the very real difficulties that the hon. Gentleman has mentioned.

Mr. Christopher Chope: Why does the Secretary of State show such dismissive contempt for a significant group of British exporters who are the innocent victims of United States trade sanctions? I have asked questions that the Secretary of State has not answered, and firms that are badly affected have written to him and received no response. He was quick to provide £40 million in compensation for the cashmere industry, so why will he not supply some help for a firm such as Beamglow in Cambridgeshire, which employs 100 people and recently invested £2.5 million in new machinery to supply the United States export market? That market has been completely cut off to that firm as a result of the sanctions, and the Government are not doing anything about it.

Mr. Byers: That was all totally wrong. There is no dismissive contempt. The Government offered support to the cashmere industry in Scotland—and in England as well—because the time at which the levy was raised by the United States customs and excise coincided with the period in which cashmere exports were going to the United States. It is a seasonal industry, and the period covering late March and April was one of particular difficulty.
As we discussed in the House last week, the real solution is to resolve the trade disputes. The Government are committed to achieving that long-term solution to the problems. The solution to the problems that companies such as Beamglow face lies in the Government using our


best efforts to ensure that the trade disputes with the United States are resolved and that free trade and commerce are able to flourish. The message has to be clear—that protectionism anywhere is a threat to prosperity everywhere. That is what we believe, and that is why we shall support measures to ensure open commerce and free trade.

Libya (Trade Relations)

Mr. Tam Dalyell: If he will make a statement on trade relations with Libya. [82362]

The Secretary of State for Trade and Industry (Mr. Stephen Byers): I am currently considering what Government services can be restored, following the suspension of the United Nations and European Union sanctions.

Mr. Dalyell: Albeit after 15 Adjournment debates on Lockerbie, I myself shall not go back to Libya until proceedings at Zeist are over. However, my right hon. Friend's reply is constructive and pleases me greatly, so I dare to suggest that he might consider himself leading a delegation to Libya. Given that Hadrian's wall is in my right hon. Friend's constituency, the descendants of the great artists of the Roman empire would be delighted to show him Leptis Magna and Cyrene, and he might be tempted to go.
Be that as it may, will my right hon. Friend say whether a problem remains with the case of WPC Yvonne Fletcher? Two years ago, I went to see Assistant Commissioner David Veness in Scotland Yard. Evidence from George Styles, the British Army's senior ballistics officer, Huw Thomas, the former consultant surgeon at the Royal Victoria hospital in Belfast, and Home Office pathologist Bernard Knight suggests that there is grave doubt about how that tragedy happened.
In view of that doubt, surely the tragedy should not form the basis for future relations with Libya. If my right hon. Friend were to visit Libya, would he reflect on whether it would be possible for him to make an apology for the permission given in 1986 for bombers based at Fairford to launch an attack on the working-class areas of Benghazi and Tripoli? That attack was as ill-conceived as the bombing attack on Al Shifa and the Sudan now turns out to have been.

Mr. Byers: Our response to the end of sanctions will be positive, but satisfactory progress must be made in a number of areas and especially in resolving the outstanding issues in the murder of WPC Yvonne Fletcher. Until that matter is resolved satisfactorily, it will not be possible to resume full diplomatic relations.
However, the lifting of sanctions means that we can examine in a far more positive light the steps that we might be able to take with regard to considering matters of trade with Libya.

Renewable Energy

Mr. Gareth R. Thomas: (Harrow, West): If he will make a statement on the Government's progress in encouraging power generation from renewable sources. [82364]

The Minister for Energy and Industry (Mr. John Battle): The Government are working towards a target of renewable energy providing 10 per cent. of UK electricity supplies as soon as possible. We hope to achieve that by 2010.
On 30 March, the Government published a consultation paper entitled "New and Renewable Energy—Prospects for the 21st Century", reaffirming the commitment to developing renewable sources of energy and seeking views on future support measures.

Mr. Thomas: I congratulate my hon. Friend on the excellent consultation document that he published before Easter. Can he assure me that the pool review will properly reflect the needs of renewable generators? What action does he intend to take to promote the prospects of solar and wave energy?

Mr. Battle: My hon. Friend may know that we recently produced proposals to draw the potential of wave energy into renewable energy sources. In February, I announced three new photovoltaic initiatives, worth £15 million—£5 million from the Department of Trade and Industry—to consider the potential of solar. Wave and solar are being brought in from the cold.
The reform of the wholesale market—the pool—is vital. If we had left it as it was, it would have squeezed out potential for renewable energy companies. Our remit to the regulator and the team considering reform in the wholesale market is to ensure space for the renewable energy companies which I believe will begin to displace traditional fossil fuels as we move into a new century.

Mr. Richard Page: I welcome the Government's commitment to renewable energy, which I vehemently support. However, has there not been a problem with the non-fossil fuel obligation rounds? No matter how large they are, and no matter how many awards are made, the number of schemes that achieve completion and production remain a problem. When they are considered in future, would the Government bear in mind the achievability of bids? What is being done in that regard? Are the Government approaching local authorities, for example, to find out whether planning permissions are likely? There is no point in taking the lowest possible bid if it will never work.

Mr. Battle: The hon. Gentleman championed NFFO when he was in government, and it is accepted in Europe and more internationally that it was a good scheme which has been successful. The hon. Gentleman is right to raise problems with implementation and planning permissions, however. We have discussed that matter in my Department, and with the Department of the Environment, Transport and the Regions. We cannot impose schemes from the centre on local communities or override local planning constraints. Projects must win support.
Planning is not the only problem, as companies are sometimes over-ambitious in their bids. We are encouraged, however, by the number of bids and their range. Bids have come in not only for wind schemes, but for landfill gas—the landfill tax is encouraging the use of methane gas. Energy from waste is also becoming increasingly popular. A range of sources will exist and


projects will continue successfully under NFFO. We are urgently addressing the planning matter raised by the hon. Gentleman.

Mr. Tony Colman: May I add my congratulations to my hon. Friend on his excellent consultation paper on renewable energy? It is a real step forward as regards sustainable development in the United Kingdom. Is he aware of the "100,000 rooftops" solar energy programme initiated by the German Federal Ministry for Economics and Technology and supported by 10-year, interest-free loans from the European Bank for Reconstruction and Development? Will my hon. Friend consider that idea for the UK, and will he consider in particular the rooftops of the houses of Putney?

Mr. Battle: I must enter one caveat. I know of the German scheme, and it is ambitious. However, one problem with PV in Britain is the structure of our houses. It may not be well known that around half the homes in Britain are more than 100 years old. We tend to do up and renovate our homes rather than build new ones. It is easier to fit PV solar in new homes than in refurbished homes. There are also price problems, as the cost of PV may be between £14,000 and £20,000. Achieving a payback on investment is difficult.
To tackle that problem, our recently announced £15 million PV initiative will examine technologies in order to reduce costs. PV will be tested on 100 homes, and we are moving towards introducing PV in a price-competitive marketplace, rather than taking the German route of direct subsidy. We also have SCOLAR schemes intended to help 100 schools to use PV so that youngsters—new scientists and technicians—learn about the technology, develop it and bring it to fruition in the new century.

Mr. Tim Boswell: We welcome both the Minister's acknowledgement of the success of the previous Government's NFFO policy and the testing and challenging objectives of the Minister's Green Paper on renewables. However, can he confirm that he has set himself an interim target of achieving 5 per cent. of energy generated by renewables by 2003? He mentioned that the pool review was an important future consideration, but does he acknowledge that, however much we do on renewable energy, it is important to ensure that generation in the short term is as environmentally friendly as possible? Will he therefore give consideration to the earliest possible elimination of the moratorium which is holding back the development of more environmentally friendly generation in this country?

Mr. Battle: In case the hon. Gentleman is under any illusion, we are trying to encourage non-fossil fuel sources under renewable energy. The strict consent policy is in position until we can reform the pool. As I said, unless we tackle that and get a new reference price for renewable energy companies, the new energy companies will be squeezed out altogether by the forces of the pool. In September, we announced a record 261 renewable energy projects for 1,177 MW contracted. If the projects in NFFO 1, 2, 3,. 4 and 5 go ahead, we will achieve that target of 5 per cent. without difficulty.
The targets are challenging, but when we include other measures—such as in response to the suggestion that disposing of waste in landfill tips is not the best answer,

and that the more tips we cap and seal, the more methane gas is generated; and that, rather than flaring it off, it is better to use that gas to generate local combined heat and power—we will find that some of that renewable energy source of supply will enable us to achieve the 10 per cent. target.

Technology and Research Clusters

Mr. Brian White: What assessment he has made of the economic impact of (a) clusters and (b) networks of high-technology, research-oriented small and medium-sized enterprises. [82365]

The Minister for Small Firms, Trade and Industry (Mr. Michael Wills): Firms often perform better when they come together in networks and clusters. The Government are working in partnership with all types of business to encourage collaboration, innovation, and the sharing of best practice.

Mr. White: I thank my hon. Friend for that reply. Many high-tech firms would not exist if they were not allowed to develop in clusters. Does he agree that the planning policy guidance issued by the Government needs to be amended to encourage clustering? Does he accept that, in other countries where clustering has been successful, it has happened because a partnership between the Government and private industry has provided the infrastructure? And does he accept that that is what is needed in this country?

Mr. Wills: I thank my hon. Friend for that. I recognise the great authority with which he speaks, gained particularly from his long experience of the IT industry. We are reviewing how the planning system can best promote the needs of clusters and the review is due to report in August.
Of course we recognise the importance of partnerships between the public and private sectors. We are doing a great deal to promote them across the board. We recognise the importance of building the right infrastructure, particularly the right electronic infrastructure. We in this Government are building the electronic future in a number of ways. I will publish shortly an important consultation document about making spectrum available for broad band wireless networks which, as my hon. Friend will recognise, will be a crucial part of that electronic infrastructure.

Mr. Colin Breed: Is the Minister aware of the deep concern in the knowledge-based industries at the potentially damaging effect of IR35—a rather hastily introduced and badly designed anti-tax avoidance measure? Will he undertake to speak to the Treasury on behalf of the industry?

Mr. Wills: The proposed new rules to which the hon. Gentleman refers are designed to remove the scope for the avoidance of tax. Rather than criticise the measure, I would have hoped that he would welcome anything that enables those who are due to pay tax to pay it.
The rules will not target the IT sector in particular. The vast majority of businesses do not avoid tax and national insurance, and will not be affected by the new rules. I am


slightly baffled by the intensity of the hon. Gentleman's concern. The Inland Revenue is working with representative bodies on the details of the new rules.
I hope that it will offer the hon. Gentleman some comfort if I say briefly that the information from the Inland Revenue to all those concerned deals with three matters: the new rules will not prevent individuals from setting up service companies; they will not prevent agency working; and they will not prevent workers and clients from arranging engagements through service companies, agencies or similar intermediaries.

Manufacturing Industry (Investment)

Mr. John Cryer: What plans he has to promote an increase in the level of investment in manufacturing industry. [82366]

The Minister for Energy and Industry (Mr. John Battle): One of the main factors holding back investment was the UK's record of macro-economic instability. Our Government have now put economic management on to a more stable footing and the recent competitiveness White Paper and the Budget introduced measures to encourage investment, especially in manufacturing.

Mr. Cryer: I thank my hon. Friend for that answer; he is correct. However, does he agree that the multilateral agreement on investment constituted a menace to British manufacturing and to investment in manufacturing, given the unstable nature of the world's financial markets and the number of multinational cowboys roving the planet?
Does the Minister agree that the proposals dreamt up by the European Commission in December, which basically amount to MAI mark 2, serve no purpose other than to act as an attack on living standards and on investment in manufacturing—not only in this country, but in other countries in the European Union? Does he agree that we should tell the EC to stick its proposals and to get on with what it knows best—maintaining the biggest gravy train in western Europe?

Mr. Battle: Like my hon. Friend, I am not into gravy trains. However, I understand that the MAI was dropped; our Government regarded it as flawed. As my right hon. Friend the Secretary of State has pointed out, it is fair to say that, in general, we are in favour of open markets, but we are determined to blend and hold together economic efficiency and social justice—nationally and internationally. We shall campaign and fight for that not only here, but in international forums.

Mr. John Wilkinson: If Her Majesty's Government's policies for manufacturing are so admirable, why have those who earn their livelihood from manufacturing been suffering so much? There is a squeeze on profit margins and, above all, a squeeze on employment. Is the Minister aware that the Trades Union Congress expects that no fewer than 250,000 jobs in manufacturing industry will be lost during this year and that the Confederation of British Industry records that, in recent months, the rate of job losses in manufacturing under this Government has been the fastest for six years?

Mr. Battle: As someone who comes from a city built on manufacturing throughout the 20th century, I saw that manufacturing base in my city sink from 52 to 22 per cent. of the economy under the previous Administration. There were 1.5 million jobs lost during the recession of the 1980s; under the Conservative Government, a million jobs were lost during the recession of the 1990s. Under the Labour Government, there are 400,000 new jobs; we have set about salvaging manufacturing from the wreckage of the previous Government's savage economic policies.

Mr. David Chidgey: Notwithstanding the comments that the Minister has just made, is he aware that the number of firms going into receivership has increased by one quarter during the first three months of this year, and that one third of them are manufacturing firms? It is indeed correct that jobs in manufacturing are now being lost faster rate than at any time during the past six years. Given the continuing high interest rates in this country and the continuing high value of sterling, does he accept that hundreds of firms are being driven out of business, and that that will not stop until the Government make a firm commitment on a programme for the UK to enter the euro?

Mr. Battle: In response to that general ragbag of proposals, I point out to the hon. Gentleman that our economy is not immune to international forces. I absolutely accept the pressure on manufacturing that now exists; I realise that—it is evident. However, we are putting in place the fundamentals to ensure that manufacturing has a chance in the future. All the measures that we have implemented—whether on corporation tax, or those introduced as a result of the competitiveness White Paper—will bolster and support manufacturing, when other people prematurely wrote it off. The hon. Gentleman should check his facts; he will find that long-term interest rates are currently the lowest for 30 years.

Mr. John Redwood: With regard to modern industry, the Minister is living in a dream world. We all know that forecasters are saying that investment by many companies will fall or be slashed, and that jobs are being lost day by day.
Will the Minister explain what he and his colleagues are up to in relation to regional assistance? Is he planning big cuts in the map? Why has he delayed making the necessary announcement? Have Ministers met recently to decide to delay the timetable of publication of the new map not only until after today's elections, but until after the European elections?
Do not manufacturers need to know whether they will be eligible for grant support, at a time when investment is under so much pressure because of the bungled economic policies of this Government? Do not voters need to know today and on 10 June what the Government's plans are for the worst-affected industrial areas?

Mr. Battle: It is vital to get regional selective assistance right, but more than half the European countries have not yet submitted their plans. It is important to get it right; we shall get it right; and we shall publish the report in due course, at the appropriate time. I am tempted to point out that the right hon. Gentleman would have


been first to jump up and accuse us of using the report for political ends had we published it during the election campaign. We are doing exactly the opposite.
On the subject of jobs, I repeat what my right hon. Friend the Secretary of State said: 3,000 new jobs have been created in Scotland and 6,500 in south Wales; more than 400,000 new jobs have been created under this Government; and a job has been created every two minutes for the past two years—that is different from what happened under the previous Government. We are working on that agenda and clawing back an economy that was sinking under the previous Administration.
On a personal note, in the privacy of the Chamber, may I ask the right hon. Gentleman whether he is really on the shortlist for the Institute of Directors job? Given the Tory prospects today, I think that we should be told.

Steel Industry

Mr. Denis MacShane: What assessment he has made of the effect of the current value of sterling on the UK steel industry. [82367]

The Minister for Energy and Industry (Mr. John Battle): Our Government have had frequent discussions with the steel industry, both management and trade unions, on the export difficulties arising from the current value of sterling. Notwithstanding current problems, the UK steel industry achieved exports of nearly £3.2 billion in 1998 while addressing underlying long-term competitiveness issues. That is a significant achievement in the circumstances.

Mr. MacShane: I am grateful to my hon. Friend for recording that success story, but the steel industry has suffered from two huge problems: first, the high rate of sterling inherited from the previous Government and, secondly, the fanatical anti-manufacturing culture of the Tory years. However, is he aware of some little rays of sunshine on the horizon? First, in its estimate for the end of the year, Goldman Sachs predicts the pound coming down significantly against the euro, which is good news for steel, although my hon. Friend should spend his wage-frozen salary on holidays abroad now, rather than wait for a weaker pound in nine months' time. Secondly, in Asia, prices are being posted higher and order books are picking up.
Will my hon. Friend consider three specific issues? First, will he ask the Chancellor of the Exchequer to put somebody from manufacturing on the Monetary Policy Committee? Secondly, will he look harder and faster at excessive electricity prices? There is no doubt that we need harmonisation with Europe on that matter, because we need lower electricity prices. Thirdly, will he agree to meet representatives of the industry to discuss those problems in the near future?

Mr. Battle: My hon. Friend champions the steel industry at every opportunity and he should be applauded for doing so. The message from the Government is loud and clear: we positively support manufacturing and we shall do what we can to ensure that there is an economic climate of support for manufacturing. To achieve lower electricity prices and to ensure that heavy industrial users of energy are not unfairly priced out is precisely the

purpose of the reform of the energy pool electricity trading arrangements. That is why we are working on that project, and I am glad to report that the work is going well. I shall be happy to meet John Bryant, the new chief executive officer of British Steel—indeed, I hope to meet him soon—and I shall continue to hold frequent discussions with the steel industry.

Milk Marque

Mr. Nicholas Winterton: When he intends to publish the Monopolies and Mergers Commission report on the selling of milk in the United Kingdom. [82368]

The Secretary of State for Trade and Industry (Mr. Stephen Byers): As I said earlier in reply to the hon. Member for Somerton and Frome (Mr. Heath), I expect to publish the Monopolies and Mergers Commission report before the House rises for the summer recess.

Mr. Winterton: Does the Secretary of State accept that dairy farmers in England, especially those in Cheshire and my constituency of Macclesfield, face grave uncertainty about the Government's intentions and plans for the future of Milk Marque? Does he agree that, because they deal with a perishable commodity, it is essential that dairy farmers have the right collection and distribution organisation to enable them to get that perishable commodity to the market?
It is quite wrong that Milk Marque should be held to ransom by the big boys in the dairy trade. That is not good for our countryside. In the face of what I would describe as the tragic fall in milk prices, strict quotas and the threat of increased milk imports, will the right hon. Gentleman seek to respond before July to the report by the Monopolies and Mergers Commission? The industry is in crisis and we should do something to help an essential and vital element of the countryside.

Mr. Byers: I understand fully the concerns raised by the hon. Gentleman. He may be interested to know that some 200 right hon. and hon. Members have made representations on this issue, and they will need to be considered when we examine the recommendations in the Monopolies and Mergers Commission's report. We will do that. I am conscious of the uncertainty, which is certainly not helpful to the industry, and I will do all that I can to publish the report as soon as possible. I give an assurance today that that will occur before the House rises for the summer recess. However, as I said in my evidence to the Trade and Industry Select Committee, we will need to take account of the many representations received before we publish our response. We must recognise and consider that information properly if we are to discharge our legal responsibilities. I assure the hon. Gentleman that we will publish as soon as we can practically do so.

Internet (Military Equipment Sales)

Mr. Nigel Beard: What plans he has for regulating the advertisement of military weapons and manuals on the internet. [82370]

The Minister of State, Department of Trade and Industry (Mr. Ian McCartney): Before I answer my hon. Friend's question, may I take a few moments to thank you, Madam Speaker, and right hon. and hon. Members on both sides of the House for the many cards, letters, e-mails and faxes that I received wishing me well during my recent illness? I assure hon. Members that the rumour that I am the first DTI Minister to be bitten by the millennium bug and survive is completely untrue. I hope that they will see from my responses today that I am back in full working order.
In the United Kingdom, the law applies equally on-line and off-line, which means that goods or services can be advertised or sold on the internet in the same way as on traditional media, provided that they comply with UK law in that area. The majority of British defence manufacturers advertise their equipment and services in the "British Defence Equipment Catalogue", which is widely available. It is an offence under the Official Secrets Act 1911 to publish classified material without authorisation, regardless of the medium of publication. In addition, the Government's White Paper on strategic export controls, Cm 3989, contains a proposal to make it an offence to publish controlled technology relevant to the development of weapons of mass destruction.

Mr. Beard: I thank the Minister for that reply. Has he seen the pages on the internet that advertise, for example, lock-picking tools that are described as "deluxe" and "the standard choice of the industry"—it does not say what industry that might be. Even more sinister are the pipe-bomb-making instructions, which carry the thoughtful caution, "Pipe bombs are killing devices", and the helpful advice, "For more bombs, click here". The intellectual market is also catered for with the "Improvised Munitions Handbook" and the "Anarchist Handbook", which provide advice on making small arms, mortars and incendiary devices and the explosives that go with them. Does the Minister agree that the greatest danger lies not in importing the American gun culture to this country, but in allowing a few criminal and crazed individuals to access such material and know-how, which leads to tragic consequences, which we witnessed recently in Brixton, Brick lane and Soho?

Mr. McCartney: I thank my hon. Friend for his question and comments. There is no one in the House who is not filled with horror, revulsion and continuing concern about recent events, some of which we can make no further comment on because they are now part of the court process—I want to say nothing that would interfere with that. We are concerned also about the incident that took place in my hon. Friend's constituency.
We are taking action and will continue to do so. We need international co-operation on enforcement in different jurisdictions. Businesses and consumers need tools to protect themselves, such as the ability to filter material for harmful content and the ability to ensure that children and young people are not able to skim the net and get information that they can use inappropriately. The users and sellers of internet and hardware products could assist in that process. Service providers should and must uphold the law on-line. However, we shall keep the options open, while remaining mindful of the potential need for future regulation. I shall report to my right hon.

Friend the Home Secretary the comments made today about issues that hon. Members would like the Government to review.
It makes sense to have laws controlling the misuse of information. For example, it is an offence to make or possess explosives under suspicious circumstances, and that is appropriate. Internationally, we need to do much more and to try to co-operate on what is a difficult matter, given the different jurisdictions.

National Minimum Wage

Mr. Ben Chapman: What assessment he has made of the effect on the UK economy of the implementation of the national minimum wage and the working time directive. [82371]

The Minister of State, Department of Trade and Industry (Mr. Ian McCartney): The national minimum wage will ensure fair competition on the basis of quality of goods and services provided and not low pay. It will help to promote work incentives, encourage firms to invest in training and improve the morale and commitment of workers, bringing about reduced levels of staff turnover and absenteeism. Productivity will improve and employers, workers and the economy as a whole will benefit.
Our assessment of the costs and benefits resulting from the implementation of the working time directive are contained in the regulatory impact assessment relating to the directive, a copy of which is held in the Library of the House.
Adjusted data from official statistics, which will be available in October, will give some idea of the extent of the shift in workers' earnings resulting from those new legal protections.

Mr. Chapman: I welcome my right hon. Friend back to the Dispatch Box. It is good to see him in such fine fettle. Does he agree that, although the minimum wage has been operating for only a short time, its competitiveness has been well established during that time? Does he agree also that, taken alongside the working time directive, trade union recognition and other measures taken by the Government, the minimum wage has vastly improved not only the lot of the British worker, but the economy?
Will my right hon. Friend compare and contrast that with the policy of the Conservative party, which not only opposed those measures but, in government, viewed the way forward as a low-wage, low-cost, low-productivity, sweatshop economy? Does he agree that the national minimum wage and the working time directive are not over-regulation, but better regulation-better for the economy and better for the workers?

Mr. McCartney: My hon. Friend is absolutely right on several counts. Nine out of 10 companies in the United Kingdom support the concept and principle of the minimum wage because of the business case for it. Four out of 10 companies complied in advance of 1 April. In all the inquiries so far, only 50 companies that have had complaints made about them have refused to implement the minimum wage and, in those instances, our inquiry


teams are following procedures to ensure that the workers in those companies get justice and receive the minimum wage.
My hon. Friend is absolutely right to say that the only people in Britain who still oppose the minimum wage are the party of Scrooges on the Conservative Benches and the handful of isolated employers who refuse to implement the minimum wage. Since 1 April, 2 million workers in Britain have received the minimum wage, including more than 180,000 in Scotland and 100,000 in Wales. It has been a tremendous success and the Conservatives are the only people who are still avoiding the question. At the next election, will they say that they will cut the minimum wage?

Mr. John Redwood: On behalf of the Opposition, I welcome back the Minister. We are all delighted that he has made a good recovery and we have missed his own special brand of invective in our recent exchanges.
The Minister believes that the minimum wage must be seen to be fair and bear a fair relationship to what others can earn. Mr. Gavyn Davies, and his loadsamoney, has obviously made it much more difficult for the Minister to set out the case. As one of the leaders of the anti-fat cats campaign when the Conservatives were in government, will the Minister take action to detach Mr. Davies from some of his loadsamoney, or has the Minister come round to our view that it is quite wrong to interfere in money that people come by legally in a private marketplace? If he has changed his view and agrees with us, where does that leave him in presenting Labour's brand of different policy and fairness?

Mr. McCartney: The right hon. Gentleman has got it wrong again. We introduced the fat-cat tax—the windfall tax—which he opposed. That tax got 250,000 young people and long-term unemployed people back to work. We have halved youth unemployment and long-term unemployment. It was he and his party who were the supporters of fat cats, and this Government who introduced social justice. He still has not answered the question of why his party is committed at the next election to opposing the continuation of the minimum wage, when that would impose a wage cut on 2 million British workers.

Mr. Redwood: Will the Minister just answer? Does he approve of Mr. Davies's remuneration or will he do something about Labour fat cats?

Mr. McCartney: Fortunately for Mr. Davies, he does not qualify for the national minimum wage—but 2 million British workers do. The right hon. Gentleman still opposes that minimum wage. He is the Scrooge, not this Labour Government.

Science Parks

Dr. Nick Palmer: If he will review ways to stimulate the creation of new companies in science parks around universities with the participation of university staff. [82373]

The Minister for Energy and Industry (Mr. John Battle): The Government are aware of the important role that incubators and science parks can play in nurturing new companies, and have supported the setting up of UK Business Incubation as a centre to promote best practice among those nurturing young companies.

Dr. Palmer: I am grateful for the Minister's comments. I understand that Cambridge university attributes the flowering of science companies partly to the university's policy of allowing staff to use research from the university to start companies. I know that not all universities follow that practice. Given the importance of the generation of new technology companies, does the Minister think that Government recommendations on how universities might best promote such activity would be suitable, bearing in mind universities' independence?

Mr. Battle:: As well as making recommendations, we are developing policies on moving the excellent research and engineering base into the productive economy. There are some 50 science parks across the country, including Cambridge, Aston, Teesside and Warwick. We want a synapse between universities, commerce and business so that new products and processes are created, resulting in new jobs. There are two relevant policies. Some £60 million seed capital funding from the university challenge fund is matched by money from universities to enable them to turn research into good business. The £25 million behind the science enterprise challenge will encourage eight centres to develop entrepreneurship alongside the excellent science developed at universities.

Mr. John Randall: I am sure that the Minister recognises the achievements of Brunel science park at Brunel university in my constituency. I am sure that he also recognises that, when companies that have been nurtured in science parks outgrow the parks, they find it difficult to locate on suitable sites nearby and very often must relocate, causing local job losses. Can his Department suggest any measures that might alleviate that problem?

Mr. Battle: I welcome the hon. Gentleman's question. Indeed, I have visited Brunel. In answering, I shall simply recall an anecdote. A person in my constituency who developed a valve wanted to set up a business and asked for assistance. From working in a bedsit, he was offered 20,000 sq ft of flatted factory floor 20 miles away. People need small and appropriate assistance. We must combine assistance to universities with support through business links. That one-stop shop will support fledgling businesses, so that they are enhanced and thrive and develop to provide new jobs.

Energy Prices

Ms Joan Ryan: What assessment he has made of the effect of current energy prices on the least affluent sections of society. [82376]

The Minister for Energy and Industry (Mr. John Battle): Tackling fuel poverty is a key priority of the Government. Although energy markets are being opened up, we are keen to ensure that the highest price is not paid


by the poorest. With the new tariff structures, we are taking measures to ensure that the fuel-poor are not priced out.

Ms Ryan: I thank my hon. Friend for his answer. While I fully accept our environmental obligations, I urge my hon. Friend and the Government to ensure that, in meeting those commitments, we do not hit hardest those least able to pay. Will my hon. Friend confirm that Labour's proposals are about a revenue-neutral energy tax levied on polluting businesses and are not, as was the case with the previous Government, about increasing VAT on domestic fuel and deliberately hitting hardest those on the lowest incomes?

Mr. Battle: I agree with my hon. Friend. The lowering of prices should be coupled with the reduction of VAT to 5 per cent. We said that we would do that and many people have benefited from it. It is fair to say that there has been a reduction of some 10 per cent. in the price of gas and electricity, but it has not been spread evenly among all consumers. Those on direct debits benefit more. We have told the regulator to look at a social action plan to examine tariff structures to ensure that the poorest do not pay the most. The market will work when all benefit, not just the better-off.
On the environmental question, it is important to ensure that we blend the reduction in prices with proper energy efficiency, including in people's homes, so that the energy that they buy does not go out through the gaps between the doors and windows. We are taking appropriate measures to insulate homes and make them energy efficient. We are doing that under other schemes, supported by the Department of the Environment, Transport and the Regions.

Parental and Family Leave

Ms Harriet Harman: If he will make a statement on parental and family leave. [82377]

The Minister of State, Department of Trade and Industry (Mr. Ian McCartney): We are committed to bringing about a more family-friendly culture in the workplace and the Government will be launching a promotional campaign to help achieve that. The Employment Relations Bill provides for rights to parental leave and time off to deal with domestic incidents. We will be consulting on the detail in the next couple of months, and will take account of the views that we receive before finalising the arrangements.

Ms Harman: I thank my right hon. Friend for his comments. Is he aware of the evidence from the United States Family Leave Commission which shows that low-income workers who need time off when their children are sick either do not take that leave because they cannot afford it or, take it, borrow money and get into debt? Will my right hon. Friend join me in urging our right hon. Friend the Chancellor to see whether there is some way that we can use the working families tax credit and extend it when people lose their pay on parental leave to ensure that low-income families do not lose out when taking advantage of those important new rights?

Mr. McCartney: The most important thing is to bed down the new culture as soon as possible, getting involvement and agreement from employers and employer organisations about the best way forward. The directive gives us that opportunity. For example, more than 2 million employees will benefit from taking time off for domestic incidents, 85,000 women will benefit each year from the maternity changes and over 61,500 employees will benefit from the parental leave changes. The Government are building up a process of involving industry in best practice, underpinned by a regulatory framework to ensure that no worker is given the sack or has any other action taken against him by his employer him when seeking to take advantage of the new rights. The Government believe that the balance is right, and so do employers. In the consultations, nine out of 10 employers supported what we are doing, and there was overwhelming support from trade unions.

Ethnic Minority Entrepreneurs

Mr. Tony McNulty: What plans he has to increase the number of entrepreneurs from ethnic minorities. [82378]

The Minister for Small Firms, Trade and Industry (Mr. Michael Wills): Ethnic minority business make an important contribution to the economy and the Government recognise that. The Department of Trade and Industry is working to reduce the barriers faced by people from all sections of the community in starting and growing successful businesses. The Department has recently joined Business in the Community's race for opportunity campaign, and one of our aims in joining this campaign will be to target support for ethnic minority-owned businesses more effectively. I also expect the Small Business Service to take account of the special needs of minority-owned businesses.

Mr. McNulty: I thank my hon. Friend for that answer. Will he join me in congratulating the dynamic contribution made, particularly by Asian entrepreneurs, to British business in general and to my constituency in particular? Will he ensure that policies such as those that he outlined will continue to facilitate the growth of entrepreneurs from ethnic minorities? Asian entrepreneurs in my constituency were severely clobbered by the woeful economic mismanagement of the Tories and will never again support their lunatic, wide-eyed policies.

Mr. Wills: I recognise the force of the last point, particularly, and am happy to join my hon. Friend in congratulating the success of entrepreneurs in his own constituency. I look forward to meeting them when I visit Harrow this summer. I am happy to give him the assurances that he seeks.

European Structural Funds

Mr. John Greenway: What account he proposes to take of the needs of upland and coastal areas in North Yorkshire in allocating objective 2 status for EU funding. [82379]

The Minister for Small Firms, Trade and Industry (Mr. Michael Wills): The Government are consulting interested parties on the designation of eligible UK areas under objective 2. All areas will be considered equally for inclusion, on the basis of need.

Mr. Greenway: I thank the Minister for that reply—and you, Madam Speaker, for the opportunity to ask the question. Does the Minister agree that low per head GDP, low population density and low average earnings, and heavy reliance on seasonal part-time and casual employment—especially in the livestock, farming, fishing, tourism, and food processing industries—should

be the essential criteria in deciding the rural strand of EU funding under objective 2? Although I realise that the Minister will not be able to give me an answer today, does he accept that, on those criteria, a formidable case can be made for retaining North Yorkshire's upland and coastal areas within the ambit of EU objective 2 funding, and that, without that funding, the economies of Ryedale and Scarborough will seriously struggle?

Mr. Wills: I assure the hon. Gentleman that his views, with all other views, will be taken carefully into consideration in the consultation period, which ends on 25 May.

Business of the House

Sir George Young: Will the Leader of the House tell us the business for next week?

The President of the Council and Leader of the House of Commons (Mrs. Margaret Beckett): The business for next week will be as follows:
MONDAY 10 MAY—Second Reading of the Northern
Ireland (Location of Victims' Remains) Bill.
TUESDAY 11 MAY—Opposition Day [11th Allotted Day].
Until about 7 o'clock, there will be a debate entitled "Labour's Pensions Failure", followed by a debate on implications of Scottish and Welsh devolution for the Westminster Parliament. Both debates will arise on Opposition motions.
WEDNESDAY 12 MAY—Until 2 o'clock, there will be debates on the motion for the Adjournment of the House.
Consideration in Committee and remaining stages of the Northern Ireland (Location of Victims' Remains) Bill.
THURSDAY 13 MAY—Opposition Day [12th Allotted Day].
Until about 4 o'clock, there will be a debate on effective parliamentary democracy, followed by a debate entitled "American Food Imperialism and European Trade Policy". Both motions will arise in the name of the Liberal Democrats.
FRIDAY 14 MAY—Private Members' Bills.
The provisional business for the following week will be as follows:
MONDAY 17 MAY—Remaining stages of the Welfare Reform and Pensions Bill.
TUESDAY 18 MAY—There will be a debate on the European Union on a motion for the Adjournment of the House. It will be the pre-Cologne Council debate.
WEDNESDAY 19 MAY—Until 12.30 pm, there will be a debate on the third report from the Health Committee on the welfare of former British child migrants, followed by a debate on the fifth report from the Environment, Transport and Regional Affairs Committee on regional Eurostar services, followed by debates on the motion for the Adjournment of the House.
Opposition Day [13th Allotted Day].
There will be a debate on an Opposition motion. Subject to be announced.
THURSDAY 20 MAY—There will be a debate on the White Paper on reforming the House of Lords on a motion for the Adjournment of the House.
FRIDAY 21 MAY—Private Members' Bills.
The House will also wish to know that on Wednesday 19 May there will be a debate on assistance to new independent states and Mongolia in European Standing Committee B. Details of the relevant documents will be given in the Official Report.

[Wednesday 19 May:

European Standing Committee B—Relevant European Union document: 5263/99, Assistance to NIS and Mongolia; Relevant European Scrutiny Committee Reports: HC 34-xi, HC 34-xiii (1998-99).]

Sir George Young: The House is grateful for next week's business, and for an indication of business for the following week.
I welcome the response to my regular requests for a debate on the House of Lords, and have pencilled in the one for the week after next. I also welcome the proposed debate on Europe, which will give the House an opportunity to debate the problems facing the Commission.
On Kosovo, there has been much political and military activity since a statement was last made to the House, on 26 April. Last week, the Leader of the House responded sympathetically to my suggestion that there should be regular opportunities for the House to ask questions and be kept informed. May we have a statement early next week, possibly on Monday, after the talks among members of the G8, and may we have another full day's debate on Kosovo before the Whitsun recess?
What arrangements does the right hon. Lady propose for debates on public expenditure and the economy? Since the abolition of the unified Budget two years ago, the House has not been told how it will perform its key role of holding the Government to account on matters relating to finance. May we have an early announcement on that?
In view of recent speculation, will the right hon. Lady tell the House whether we might expect a statement soon on the much-delayed freedom of information Bill? Finally, what has happened to the leak inquiry into the Macpherson report? The leak happened two and a half months ago, and there are a limited number of suspects. Might we have a statement on the outcome of the inquiry next week?

Mrs. Beckett: First, I am grateful to the right hon. Gentleman for acknowledging that we have found time for a debate on the White Paper on reform of the House of Lords. He is right to say that the pre-Cologne Council debate will allow hon. Members an opportunity to raise a number of matters, including the affairs of the European Commission.
We are giving full consideration to how we can fulfil our responsibility to keep the House informed about Kosovo—a responsibility that we have faithfully carried out so far. I expect that the right hon. Gentleman knows that discussions are taking place on that. I take on board his request for a statement, perhaps early next week, and for another full-day debate before Whitsun. We shall give that request favourable consideration.
I sympathise with the right hon. Gentleman's request for an early announcement on arrangements for public expenditure and economic debates. We are pursuing that, and I shall report to the House as soon as I can. I also hope to be able to report soon on the freedom of information Bill.
I confess that I have not been following the timing of the Macpherson report leak inquiry.

Mr. Eric Forth: You should be.

Mrs. Beckett: I remind the right hon. Gentleman that it is not an inquiry into anything that the Government have done; it is an inquiry into what went wrong in the Macpherson commission. The commission has readily acknowledged that the Government were not at fault. We shall give the House information when we can.

Mr. Neil Gerrard: Has my right hon. Friend seen the written answer that I received from my right hon. Friend the Secretary of State for Defence yesterday? He said:


I have had no discussions on the use of depleted uranium with my NATO counterparts. The United Kingdom has not used DU ammunition in the Balkans. It is a matter for the individual nations as to what ammunition they employ."—[Official Report, 5 May 1999; Vol. 330, c. 383.]
Does my right hon. Friend the Leader of the House accept that a cynic outside the House might well interpret that answer as meaning that such ammunition has been employed? Will she ask my right hon. Friend the Secretary of State for Defence to make a statement to the House to explain why, in a war conducted by NATO in which we are led to believe that senior politicians such as him are regularly involved in discussing strategy, we cannot be told whether NATO nations are employing such weapons?

Mrs. Beckett: I am afraid that I have not seen the answer to which my hon. Friend refers. I understand the concern that he has expressed. Like him, I have seen several press reports, all of which have seemed highly speculative—"It is possible"; "It might be"; and, "If so would it not be the case?" It is hypothesis piled on hypothesis. He is undoubtedly right to say that some people will assume that something is being hidden. However, those reports may well be no more than speculation. As I have already said, we intend to keep the House informed. That may give my hon. Friend an opportunity to raise the issue.

Mr. Edward Davey: I thank the Leader of the House for her statement, particularly for notice of the timely debate on the European Union. Will she find time for a debate on incorporating first-aid training into the national curriculum? The case is well set out in early-day motion 596, which has attracted support from hon. Members on both sides of the House.
[That this House regrets that thousands of lives have been needlessly lost because the public has not been given lifesaving and first aid training; welcomes the work of the St John Ambulance, who celebrate their 900th Anniversary this year, and other charities in providing such training in school; acknowledges the millions of pounds of savings available to the NHS if more people were empowered to take lifesaving action; and calls upon the Government to incorporate first aid training into the National Curriculum.]
Does the right hon. Lady agree that such a debate would enable the House to acknowledge the work done by the St. John Ambulance and other uniformed organisations in first-aid training and would help us to empower more of our citizens to give life-saving support as we saw many Londoners so bravely do after the appalling recent bombings in the capital?

Mrs. Beckett: First, I thank the hon. Gentleman for acknowledging the importance of debates on the European Union. Secondly, we all share his admiration for the work of the St. John Ambulance. I entirely take his point that the aid and assistance that people in London were able to give those who were injured by the recent bombs were improved by training. The Government are examining ways to introduce such training in schools, and members of the St. John Ambulance are about to offer such training to Members of Parliament—a truly courageous act. The

hon. Gentleman's suggestion that it should be included in the national curriculum takes the matter further, but the Government are considering how to improve such training.

Mr. Tony Colman: On behalf of the whole House, may I thank you, Madam Speaker, for the excellent address you gave us yesterday morning in a very moving ceremony in the Queen's Gallery to celebrate the tremendous achievements of the Council of Europe on its 50th anniversary? Will my right hon. Friend the Leader of the House consider a further debate to celebrate the achievements of the Council of Europe? 1 realise that debates on Europe repeatedly expose divisions in the Conservative party on the subject, but, despite that, I feel that the House should have a full debate on those tremendous achievements in the very near future.

Mrs. Beckett: I am grateful to my hon. Friend, particularly for his acknowledgement of the importance and value of Madam Speaker's address. Having heard her speak on a number of occasions, I know that she always does the House credit—although whether we always do her credit is quite another matter. As for a further debate on the Council of Europe, although I am attracted by my hon. Friend's suggestion that it would expose divisions within the Conservative party, I feel that Conservative Members need no help from us in that respect, and I cannot find time for an extra debate on Europe.

Sir Peter Emery: Having heard Labour Members congratulate you, Madam Speaker, on your speech yesterday, let me acknowledge on behalf of the Opposition that yours received more applause than the other three speeches and it was much to your credit.
I have a question on Kosovo for the Leader of the House. Does she realise that statements by Ministers do not in themselves provide an adequate opportunity for debate? An illustration of that was the statement by the Home Secretary yesterday, when, although a number of hon. Members asked questions, others were still waiting to participate when time was called. Does she realise that Kosovo has three aspects: the military factor, the negotiations and foreign affairs issues, and the massive problem of refugees? Can she find perhaps half a day of Government time to discuss the problem of refugees—how they will be dealt with and what assistance they will receive—sometime in the immediate future?

Mrs. Beckett: I entirely share the right hon. Gentleman's view that statements are not enough and that there must also be debate—indeed, that is why the Government have repeatedly found time for both and will continue to do so. I take his point that there are several aspects to the matter and that debates may focus on one aspect rather than another. However, I would prefer to leave that in the hands of the House. When we can, we provide Government time for debate, and it is a matter for the House whether it wishes to focus on one aspect rather than another; otherwise, we should be in danger of fettering the concerns of hon. Members.

Mr. Tam Dalyell: Following the point made by the right hon. Member for East Devon (Sir P. Emery), the Chairman of the Select Committee on Procedure, albeit that in parliamentary terms we both


might be out of Jurassic park, what does my right hon. Friend think that people such as Judith Hart, for whom she once worked, Jack Mendelson and Michael Foot, whose parliamentary activities kept us out of the Vietnam war, would have thought of a Leader of the House who said that we have statements to keep Parliament informed? In the old days, it was a much wider matter than keeping Parliament informed; there had to be parliamentary debates on substantive motions so that Members of Parliament could reach decisions by vote. I do not doubt that the Government would get a huge parliamentary majority, and that the dissenters among us may be few. However, given what is happening in the House of Representatives, the Folketing and the Bundestag; given the grave doubts of the Italians, with Mr. Rugova coming to talk to the Italian Prime Minister; given the dissatisfaction of the Greeks; and given the enormous environmental problems, with toxins spewing forth from chemical factories throughout Europe, is it sufficient for the House of Commons to agree to be kept informed? Is it not high time that the House registered an opinion? This is a parliamentary matter, not a party matter.

Mrs. Beckett: I am not sure whether my hon. Friend entirely followed what I said to the right hon. Member for East Devon (Sir P. Emery), who is the ex-Chairman of the Procedure Committee.

Mr. Dalyell: Forgive me.

Mrs. Beckett: It is the right hon. Gentleman's successor, the hon. Member for Macclesfield (Mr. Winterton), who needs placating.
I said to the right hon. Member for East Devon that the Government would continue to find time for statements and debates. As for what some of our distinguished predecessors—including my great and very dear friend Judith Hart—would have thought of these proceedings, they all, as great parliamentarians in their day, would have anticipated that the Leader of the House would look into the precedents with regard to the handling of discussion in the House during a campaign—namely, the provision of statements and time for debates. I have done that. I have looked into precedents from the second world war, the Falklands war and the Gulf war.
Our predecessors would also have expected the Leader of the House to look at the precedents with regard to how Parliament comes to decisions on these matters. I greatly respect the strong views of my hon. Friend, who strayed at the end of his question into whether Parliament should make a decision on a substantive motion. I tell him again that there is no precedent for that whatever.

Mr. Eric Forth: The Leader of the House will be aware that the Home Secretary has today pronounced on the matter of Mr. Fayed's citizenship. She may recall that, on the previous occasion when this matter was considered by the former Home Secretary, the present Home Secretary—in his previous Opposition incarnation—made a fuss about the need for transparency, for statements and for details to be given. Does the Leader of the House share my surprise that, apparently, no such details have been provided as yet? Will she therefore provide time as a matter of urgency for

the Home Secretary to come to the House to give us in great detail the reasons for the decision that he has made today?

Mrs. Beckett: The mistake that the right hon. Gentleman makes is in drawing a parallel between someone not knowing the reasons why their application has been refused and someone knowing the reasons. My right hon. Friend the Home Secretary has announced the refusal, and has made plain his reasons, in full, to Mr. Al Fayed in a letter to his solicitors. However, my right hon. Friend believes that it is for Mr. Al Fayed to decide whether he publishes those reasons. Mr. Al Fayed now knows where he stands, whereas he did not before.

Mr. Mike Gapes: Will the Leader of the House find time for an early debate on British identity and British nationality, so that we can make it clear to the wilder forms of nationalist extremism in Scotland and Wales, and to the growing English nationalist sentiment in the Conservative party, that my constituents—many of whom came to this country as refugees in the 1930s from Austria and Germany, with others coming from Somalia and fleeing from Saddam Hussein's regime in Iraq—feel proud to be British? In such a debate, we could make it clear that Britain includes people of all religions, all cultures and all nationalities. We are proud of that, and we will not tolerate the wilder forms of separatism and nationalism that are being pedalled in Scotland, in particular.

Mrs. Beckett: I entirely share my hon. Friend's view that one of the honourable things about the history of this great country is that it contains people of a rich variety of shades, cultures, opinions and religions, and has always done so. That is something that we celebrate, rightly. I am confident that many will consider it unutterably complacent to say so, but I fear that I share the view of a journalist who wrote recently that the other characteristic of the British identity is that one does not need to get excited about it, because it is a matter of feeling secure in that identity.

Rev. Martin Smyth: I welcome the fact that the Northern Ireland (Location of Victims' Remains) Bill has a financial measure attached to it, because relatives have already been seeking compensation for the cost of burying their dead.
Can we have a statement from the Chancellor or from someone else on a growing problem in Northern Ireland? One person is estimated to have an income of £2 million from smuggling, and some people are making £40,000 to £50,000 a week. Is it not time that we had more customs officials employed to deal with the haemorrhaging of money that should go to the Treasury?

Mrs. Beckett: The hon. Gentleman makes a serious point. As I understand it, resources for customs have been increased as a result of the comprehensive spending review. I have little doubt that my right hon. Friends the Secretary of State for Northern Ireland and the Chancellor will keep the matter under review, because we are keen to have effective enforcement of law and order.

Mr. John Cryer: I have asked my right hon. Friend before for a second debate on the Jenkins


report on electoral reform. My request is given greater urgency by the emergence of a shadowy organisation called Make Votes Count. Has my right hon. Friend seen early-day motion 592?
[That this House notes recent articles in the Tribune newspaper regarding the decision by the Make Votes Count campaign to appoint lobbyists Lawson Lucas Medelson to run its public relations; is alarmed that LLM is not a member of the Association of Professional Political Consultants and is therefore not bound by its ethical code; and condemns LLM's threat of legal action against the Amalgamated Engineering and Electrical Union as an attempt to suppress debate on electoral reform.]
As far as I can gather, LLM is attempting to use legal action to suppress the debate. That demonstrates that the debate on electoral reform has moved to a more vicious and sectarian stage, at least on the part of the Jenkins supporters.
We need a second debate because 50 Labour Members were unable to speak in the first debate. I suspect that the vast majority of them wanted to make it clear that they would have nothing to do with the bucket of pigs' entrails that is the Jenkins report.

Mrs. Beckett: I note my hon. Friend's somewhat colourful language. I have heard of the campaign, but I am not aware of the legal action to which he refers. I can certainly assure him that it receives no financial support from the Government and is unlikely to do so.

Mr. Nicholas Winterton: The Leader of the House will be aware that the second runway at Manchester airport is in an advanced state of construction. She will also know, as it is a matter of importance to the United Kingdom as a whole, as well as Manchester in particular, that the Commonwealth games are to take place in and around that city in 2002. People right across the party political spectrum—local authorities, business, Manchester airport itself and others—are deeply concerned that the infrastructure to serve both the airport and the games is inadequate.
Will the Leader of the House arrange for the Minister for Roads and Road Safety to make a statement as soon as possible about the need for roads to the south and south-east of Manchester, in north Cheshire, and especially the Manchester airport eastern link road, the Macclesfield-Poynton road improvement and the Poynton bypass, which are essential if we are to serve those tens of thousands of people who will be attracted to both the airport and the games? That is critical. It is vital that the multimodal study be concluded.

Mrs. Beckett: I understand the hon. Gentleman's concern, although in many ways the Manchester area has very good infrastructure compared with other parts of the country. I accept that there may be deficiencies that are causing concern. I fear that I cannot undertake to find time for a special debate in the near future, but I remind him that Environment, Transport and the Regions questions are on Tuesday 11 May, and he might find an opportunity to work the subject in there.

Mr. Gareth R. Thomas: I was pleased to hear my right hon. Friend announce a debate on the

House of Lords. Does she agree that part of that debate should focus on the disgraceful decision by the other place to overturn key sections of our working families tax credit proposals? Is that not proof, if more proof were necessary, that the hereditary peers are completely out of touch with modern realities, especially concerning the child care needs of working families, and that sensible reform, long blocked by the Conservative party, is long overdue?

Mrs. Beckett: My hon. Friend is right to say that sensible reforms such as the working families tax credit are long overdue. It is part of the Government's multi-pronged approach to relieving the worst of the poverty for families in work which grew under the Conservative Government. Like my hon. Friend, I was astonished to learn that that was a matter in which the House of Lords thought fit to meddle. It is indeed a further example of the fact that that Chamber is now somewhat out of touch with modern realities and the modern world, and it shows that yet again it is acting on behalf of the few, rather than the many.

Mr. Peter Brooke: Although the coincidence of timing between the Select Committee on Northern Ireland Affairs' visit to the United States and the Northern Ireland legislation next week, which I raised with the Leader of the House last week, has had some of the unfortunate consequences that I foresaw, I would still like to express my appreciation for the efforts that she made to find out whether anything could be changed.
I shall also ask a question supplementary to that asked by the hon. Member for Belfast, South (Rev. Martin Smyth), and say that one of the arguments in favour of a debate on smuggling across the Irish border is connected with a speech made by the Economic Secretary to the Treasury in Committee on the Finance Bill earlier this week. The hon. Lady said that the issue of a buffer zone such as that between Germany and Holland, which had been raised in the debate, was a matter for the Northern Ireland Office. However, Customs and Excise, for which she herself answers in the House, put that idea in a memorandum to the Select Committee. Is there not a sense in which the Treasury and the Northern Ireland Office both seek to avoid their particular responsibilities for dealing with that increasingly urgent question?

Mrs. Beckett: I thank the right hon. Gentleman for his kind remarks; I regret that that unfortunate clash has arisen. Nevertheless I hope that between us, with some good will, we can resolve it without too much difficulty.
I take the right hon. Gentleman's point about the concern expressed both by him and by the hon. Member for Belfast, South (Rev. Martin Smyth) about smuggling across the Irish border. The Government have provided resources for a substantial number of extra customs officers, so in that sense the Government are not ignoring the matter. The right hon. Gentleman is right to say that the Treasury answers for Customs and Excise in the House, and I shall draw his remarks to the attention of my right hon. Friend the Secretary of State for Northern Ireland and of Treasury Ministers, because it is important that we have the right liaison. I assure the right hon. Gentleman that all Departments are concerned about such matters.

Sir Sydney Chapman: As Members are being elected to the Scottish Parliament today, does


the right hon. Lady agree that the so-called West Lothian question now assumes immediate urgency? Will she join me in thanking my right hon. Friend the Member for North-West Hampshire (Sir G. Young), the shadow Leader of the House, for taking the initiative and arranging for the matter to be debated during the Opposition day debate on Welsh and Scottish devolution next Tuesday? Because of the vital importance of the issue within the United Kingdom constitution, will the right hon. Lady ask the Prime Minister to intervene in the debate and let us know exactly where the Government stand on this burning question?

Mrs. Beckett: Personally, I share the view expressed either by Sir Malcolm Rifkind or by Sir Alec Douglas-Home, or possibly by both, that the West Lothian question did not need to be answered but could readily be put on one side; devolution could continue without it. Both men were in key positions in the Conservative party when they said such things—but of course that was longer ago than last week.
The hon. Gentleman also asked for an early discussion to settle the matter with speed. I remind him that the hon. Member for Macclesfield, the Chairman of the Procedure Committee, is now carrying out an inquiry into precisely how devolution may affect this House. With respect, I must tell the hon. Member for Chipping Barnet (Sir S. Chapman) that no one who sensibly wants the House to develop effectively and efficiently wants to rush to judgment on such matters.

Miss Anne McIntosh: Will the Leader of the House agree to make time for an early debate on another European matter—the revision and amendment of the sixth VAT directive, which is now before the Council of Ministers? The amendment would, for the first time, allow church repairs to be exempt from VAT. I am sure that the whole House will support my campaign to allow that to happen, but the Paymaster General seems reluctant to apply for the exemption. It would apply to all labour-intensive industries, and would end the anomaly between the building of new churches, which is exempt from VAT, and the repair of existing churches, which is subject to VAT at 17.5 per cent. Can we make time for an early debate, before the matter is decided in the Council of Ministers?

Mrs. Beckett: I sympathise with the hon. Lady's concerns, and I am well aware that hon. Members seek

to relieve all sorts of worthy causes from the imposition of VAT. Experience suggests that the boundaries are complicated and subject to much discussion. I shall draw her remarks to the attention of my Treasury colleagues, but I fear that I cannot undertake to find time for a special debate on the issue in the near future.

Mr. John Bercow: May we have an early debate in Government time on the problems of small businesses? Given that businesses with fewer than 100 employees constitute 99.6 per cent. of British enterprises, employ 50 per cent. of the private sector work force and produce two fifths of national output, but that there has been a massive rise of 32 per cent. in small business bankruptcies compared with the same period last year, such a debate would give the Secretary of State for Trade and Industry a chance to expand on his recent statement that
we as a Government have not got regulation right".—[Official Report, 29 April 1999; Vol. 330, c. 555.]
He could explain to the House and the country how and when he intends to reverse the damaging increase in regulation that his Government have spawned, and how they will create a climate in which the seedcorn of this country's prosperity can survive and flourish.

Mrs. Beckett: I am well aware of the importance of small and medium-sized businesses and have long been so. We are all mindful of the importance of trying to reduce the burden of regulation, whether on small or other businesses, but I accept that it impinges especially on small businesses. I was a little surprised that the hon. Gentleman mentioned bankruptcies. Whatever recent difficulties have arisen, there is no doubt that bankruptcy levels under this Government pale into insignificance beside the record of the Conservative Government whom he supported. We strongly believe that it is important to try to get the burden of regulation lifted as much as possible and, indeed, we hope to reverse the Conservatives' record of talking about reducing the burden of regulation but actually increasing it out of sight.
On the Government's general record, I remind the hon. Gentleman that it was only recently that small business commentators were moved to say when my hon. Friend the Member for Hornsey and Wood Green (Mrs. Roche) left the Department of Trade and Industry that she was the best Small Business Minister there had been for years.

London's Health Service

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Pope.]

The Secretary of State for Health (Mr. Frank Dobson): I cannot possibly start this debate on the modernisation of London's health services other than by paying tribute to the emergency services, and in particular the staff working for the NHS in London, for their swift, effective and highly professional response to the bomb outrages in Brixton, Brick lane and Soho. The staff involved all did an amazingly good job. Like the victims, the staff who tended to them were black, white, Asian, men and women, straight and gay, all united in that singular humanitarian ethic that towers above all others—the commitment to help our fellow humans when they are in desperate need.
In Brixton, 15 ambulances and three motor cycle paramedics went to the scene. The first ambulance was on the scene in eight minutes. By the time it arrived at King's College hospital with the first of the wounded, emergency plans had already swung into action. Staff already on duty had made all the necessary preparations. Other staff had been called back in. Yet others had rushed in of their own volition just in case they could help. The same was happening at St. George's hospital and at St. Thomas's hospital.
After the Brick lane explosion, five ambulances were dispatched to the scene. The first arrived within seven minutes, and was followed by emergency teams from University College hospital, helicopter emergency services, and the immediate care doctors. The Royal London hospital and other nearby hospitals were fully prepared to receive the victims. All displayed the same state of readiness and commitment that were evident in south London the week before.
Last Friday, 21 ambulances were dispatched to the scene in Soho. The first arrived in four minutes. Emergency teams from UCH were there shortly after, and once again the nearest hospitals—University College, St. Thomas's, Guy's, the Royal London and St. Mary's—all responded just as the others had in east London a week before and in south London two weeks before. All performed magnificently. The UCH Middlesex hospital did so despite operating with emergency services in Gower street and some in-patient services at the Middlesex site following the closure of the main UCH building in 1993.
This brilliant performance by London's NHS was partly because of the commitment and skill of the staff concerned and partly because of the painstaking contingency planning involving clinical and non-clinical staff, and management. One young nurse whom I met at the UCH accident and emergency department last Saturday evening explained to me that it was the first major incident she had been involved in. She had expected it to be chaotic, but it was not. She said everybody knew what they were supposed to be doing and got on with it.
I had gone there 24 hours after the bomb, partly in my role as the local Member or Parliament, to thank her and her colleagues. Some of the staff had not really had a rest since the night before, but when I met them they were involved in four main tasks. Some were still looking after

badly injured bomb victims. Others were dealing with the "run-of-the-mill" patients turning up or being brought into their busy accident and emergency department that Saturday evening. All were considering what lessons could be learned, so they could do even better when the next major incident occurred, whether as a result of accident or terrorism. One senior member of the nursing was laboriously sorting out all the special kits that they use for major incidents, replenishing stocks of dressings and drugs, so that they would be ready if there was another major incident that night.
Far too often, all that is taken for granted, as if such a highly organised response to disasters was natural and spontaneous—something that just happens. But it does not just happen: it depends on professionalism and commitment, planning and accumulated experience.
That organised response is delivered by a public service, by people who do not just talk of the public service ethic, but who live by it. As my right hon. Friend the Prime Minister said at the charter mark awards ceremony last year,
This government values public service; this government is proud of its public servants. What made you choose this career is what made me go into politics—a chance to serve, to make a difference. It is not just a job. It is a vocation. Britain relies on that ethos of public service, and we need to rekindle it if we are to deliver improved public services.
The NHS staff who looked after people after the bombs in Brixton, Brick lane and Soho look a bit embarrassed when one praises them to their faces. They say that they were only doing their jobs. They chose to work in the NHS because of the people they are. They are not motivated by share options or by windfalls from stock market flotations. They do it because they work for the national health service, which is committed to trying to provide the best health services for everybody—the best for all, on the basis of quality and equality, and that is what they deliver.

Mr. Peter Brooke: I am most grateful to the Secretary of State for giving way, not least because the Middlesex hospital is on the border that separates my constituency and his, and because some of my constituents were among the patients treated. I should like to add my commendation and tribute to those volunteers from hospitals that were not in the front line who spontaneously came in to see whether they could help.

Mr. Dobson: I certainly join the right hon. Gentleman—my good neighbour—in paying tribute to those from other parts of the health service who came forward to volunteer their help. The right hon. Gentleman accompanied my right hon. Friend the Home Secretary on a visit to the UCH Middlesex hospital, which I know was much appreciated.
The NHS in London provides health care for 7 million people who live in London, 1 million who come to work in London and 25 million tourists and other visitors. The service has a hard task. Up to now, that task has not been made any easier by the rundown state of many hospital and other NHS buildings, by disproportionate cuts in beds in London, by the unreliable nature of much vital plant and equipment and by the absence of a Londonwide NHS organisation charged with planning and delivering


London's health and health care as a whole. We need to modernise London's health service, and that is what we are doing.
The population served by the NHS in London is very mixed. Some people and some neighbourhoods are prosperous and healthy. Others are quite the reverse. In some parts of London, unemployment, low pay, poor housing, crime and disorder, and environmental pollution combine to undermine the living standards and health of hundreds of thousands of local people. The Government's policies are intended to reduce gross inequalities in health, partly by improving health care in the most deprived areas and partly by making those areas and the people who live in them less deprived in the first place.
At the general election, we promised Londoners action on both aspects. We are keeping those promises. Within seven weeks of taking office, I set up the Turnberg review to provide an independent report on what the NHS in London needed. Within seven months, I was able to publish the Turnberg report and announce that the Government had accepted every one of its recommendations. They covered primary care; community health services; mental health services; general, specialist and teaching hospitals; emergency services; and teaching, research and development. All of them aim to improve the treatment and care of patients.
We have got on with making the improvements that are needed. Work is under way on building schemes worth more than £400 million, including new hospitals in Bromley and Greenwich and additional modern hospital buildings at Guy's and St. Thomas's, Central Middlesex, Hammersmith and Queen Charlotte's, Barnet and Homerton hospitals. National priority has been given for a further £350 million to be invested in a modern new hospital at UCH, and major modern developments at King's College, St. George's and West Middlesex University hospitals.
Subject to national prioritisation, further investment of more than £500 million is planned, including new hospitals at Oldchurch and the Royal London, and substantial modernisation at Bart's, St. Mary's at Paddington basin, Queen Mary's at Roehampton, Newham and Whittington. All over London, smaller modernisation schemes have been completed, are under way or will be under way shortly. More than £300 million will be invested in these smaller-scale improvements and modernisations over the next three years. More than £100 million is planned for this year.
London is a major centre of medical research, and we intend to keep it that way because it is good for Britain's reputation as a world leader in medical science and also good for patients. An excellent example of the role of research and development in improving health care delivery is the improvement in mortality of children with meningococcal septicaemia over the past five years in the children's intensive care unit at St. Mary's hospital, Paddington. By centralising critically ill children from the south of England in a single unit that can undertake research into the disease and assess new forms of treatment, greatly improved mortality has been achieved. St. Mary's has 5 per cent. mortality for children suffering the sudden shock associated with meningitis, the lowest rate reported anywhere in the world. That is an important example of the benefits of combining research and service on relatively rare diseases.
The Turnberg report recommended that we review specialist services in west London, and we have made progress. A west London partnership forum chaired by Lord Newton of Braintree, a former Tory Cabinet Minister, was established last summer to advance that work.
We want local people to receive accessible top quality treatment and care. We also want Imperial College medical school and its NHS partners in west London—especially the Royal Brompton, Harefield, Hammersmith, St. Mary's, Chelsea and Westminster, and Charing Cross hospitals—to maintain and enhance their national and international reputations in medical education, medical research and the development of new, improved, science-based treatment and care.
The leading clinicians in the area have been involved in formulating this new approach. I welcome this imaginative and long-term approach to the problems and opportunities of the area and look forward to receiving further details in due course.
We will not allow the development of these long-term plans to interfere with immediate developments in both services and research in west London. As I have personally told Sir Magdi Yacoub, there will be no planning blight. I am therefore pleased to announce that, over the next three years, we will be investing up to £2 million of NHS resources in a new heart sciences research centre at Harefield hospital. We hope shortly to approve similar investment in a new patient services centre at Harefield and in the Fulham wing at the Brompton hospital.
Work is continuing on the plans to build a new hospital at the Royal London in Whitechapel and transform Bart's into a major specialist cardiac and cancer centre. The distribution of cardiac services between the two sites has been sorted out with the help of Sir Terence English, and I hope to be able to announce the same about cancer services fairly shortly.
In the meantime, children's services have been successfully transferred from Queen Elizabeth's Hackney to the Royal London site, and the centre was opened on 28 October 1998 by Her Majesty the Queen. That was a big boost for the Royal London and demonstrated the commitment of both staff and management, who maintained a top-quality children's service while first meticulously planning the move and then doing the actual moving.
In the meantime, work to complete the Homerton hospital is well under way. The new A and E unit opened last December, the new children's and out-patients' departments will open next month and the work will be completed in May next year. Plans for extra modern acute services at Newham general have been approved.
The east end has also benefited from the extra £9.6 million which went with being designated a health action zone which is concentrating on children, young people and mental health. One programme covers refugees in the area, many of whom are suffering from post-traumatic stress. Other deprived areas in London designated as health action zones are Lambeth, Southwark and Lewisham, Camden and Islington, and Brent. All are helping reduce health inequalities by targeting special help on the most deprived groups in the most deprived areas.


Since the publication of the Turnberg report, which emphasised the need to improve primary care, altogether 73 new or improved GP premises have been opened in London in the past year, and many more are to come. As a result, the proportion of substandard primary care premises in London has fallen from nearly one half to less than one third.
As in the rest of the country, primary care groups have been established in every part of London. The 66 PCGs bring together for the first time local GPs, nurses, people from social services and lay members—all working to improve the standard of primary care, commission improved services from local hospitals and identify and tackle local causes of ill health—all this in place of the previous Government's divisive internal market, which set doctor against doctor and hospital against hospital.
It will take time before all the benefits of this approach begin to work through, but let me give the House a few examples of how London PCGs are improving treatment and care for their patients.
The Harrow PCG is extending physiotherapy and dietetics services across the PCG, and developing and extending a community leg ulcer clinic which has transformed the treatment of leg ulcers in the area. The Bexley PCG is maintaining and extending physiotherapy, dermatology and chiropody services, and extending rheumatology outreach clinics PCG-wide. The Newham PCG is retaining and extending counselling, dietetics and physiotherapy across all the practices in its area.
Their work will tie in with the health improvement programmes which every health authority now has to draw up to identify and tackle the health and health care needs of their area. It is a modern, across-the-board approach which, again, is possible only because, under the new Government, all parts of the NHS are working together in place of the obligation to compete placed on them by the previous Government.
As recommended by Turnberg, we have increased investment in mental health services and improved co-ordination between the NHS, councils and voluntary agencies, not only in London but throughout the whole country. Last December, I announced a £700 million strategy to deliver safe and modern mental health services. That money is being invested in providing enhanced rapid response teams, more 24-hour staffed beds and more continuing care in the community. In London this year, health and social services will receive about £37 million extra for mental health services.
As recommended by Turnberg, work has begun on developing a Londonwide mental health strategy, drawing on the opportunities provided by new information technology. Part of that has been called by the people operating it a virtual institute in mental health research and development; it is a technological link, bringing together people in London who are doing research into mental health to provide better solutions for patients.
The movement of people and patients in London is very complex. It does not reflect the official, artificial boundaries of health authorities and trusts; that is why a Londonwide office makes so much more sense than the previous arrangements, whereby responsibility for London was divided between two regions, both of which

also had responsibilities outside London. Therefore, to a quicker timetable than that envisaged by Turnberg, I have established a Londonwide regional office. The upheaval involved was kept to a minimum by good management, and the staff appear to have taken to their new role like ducks to water. Their work has been given a new purpose and dynamism. They will not be expected merely to formulate plans in consultation with the rest of the NHS in London; they will be expected to see to it that the plans are implemented.
The change has brought together health and social care programmes Londonwide, so that they can better work together to promote better and more effective working between the NHS and local social services in every part of London. That is crucial in raising the quality of service offered to elderly or disabled people and people with learning difficulties—for example, by playing a part in helping to improve the joint work among the NHS, local councils and voluntary organisations. That is already paying dividends. All over London, new arrangements are being made to help to look after patients better at home, so that elderly people do not have to go into hospital unnecessarily for want of proper care at home. Patients who have completed their hospital treatment can be discharged in the sure and certain knowledge that, between the local health and social services, there will be someone to look after them properly.

Mr. Simon Hughes: The Secretary of State referred to patients being discharged into the community and to the welcome review that he has initiated into the number of beds in the NHS. Given those points and the concerns over beds in London, can he tell us whether he has reached any conclusions about the number of beds we need, not in our acute hospitals, but in the community, for respite, recuperation and discharge? If not, when may we have such an assessment? That is one of the pressures of which we are all aware; there must be non-intensive care facilities for people who are nearly ready, but not quite ready, to return to their homes.

Mr. Dobson: Some of the national work has been completed. The London office is now working on the detail of what is needed in particular localities in London. That stretches from intensive care at one end to ensuring that people can sleep happily in their own beds at the other—with various intermediate stages. I hope that we shall be able to make some announcements on that matter before the summer. Some action is already being taken: additional intensive care beds are being provided and, in some places, more is being put into providing reception wards behind the accident and emergency departments, so that such care is better conducted. I hope that we shall have some detailed intentions to announce before the summer.
In the meantime, the NHS in London has been delivering treatment and care to Londoners as never before. Last year, London hospitals treated record numbers of patients. Record numbers of people came off the waiting list, record numbers of emergencies were dealt with and record numbers of out-patients were treated. London's hospitals have made a huge contribution to the record national fall in waiting lists. The final figures are not yet available, but figures for the end of February show that the London total of people waiting for in-patient


treatment was well below the number that we inherited when we came to power in May 1997, and that the total waiting list had fallen by 37,000 since March 1998. I can safely predict that the next set of figures will show a further drop of several thousand, for which the people involved are to be commended.
Those are not the only changes that we have made to health care in London to make it more modern and dependable. NHS Direct, the 24-hour nurse-led helpline, now covers 1.4 million people in west London and 700,000 million in south-east London, giving Londoners their first access to that most popular and successful service. In west London, the service is being organised, not by the ambulance service, as is usual, but by the Harmoni GP co-operative. At the co-operative's instigation, NHS Direct in west London is already being extended to provide access to GP out-of-hours services, mental health services and social services. NHS Direct will be extended to cover a further 1.9 million people in London by December of this year, and it will cover the whole capital next year.
London can look forward to other services that are currently being tested in other parts of the country, such as NHS Direct not only taking calls, but making them, which is a positive development. Already in West Yorkshire, during troughs in the flow of incoming calls, nurses ring patients to remind them of appointments with their doctors or for screening services; and in the west midlands the service is about to proceed with an arrangement whereby people who have been discharged from hospital are telephoned by NHS Direct to check their progress. The development of NHS Direct will enable dramatic improvements to be achieved in the general standard of health care in this country, especially because, in every part of the country, that development is taking place in co-operation with existing clinicians, doctors, nurses and others.
As everyone knows, one of the major problems besetting health care in the capital has been staff shortages, especially of nurses. The previous Government used to deny that there was a shortage of nurses, but, unlike them, we have not buried our head in the sand. Our efforts to improve nurse recruitment received a special boost in this year's pay awards: the London allowance was increased by 15.4 per cent. That, combined with the national awards, means that a newly qualified nurse in London now starts work on a salary of £17,325, and that two thirds of all nurses in London will be paid more than £20,000 a year.
When the new pay award was announced, we launched a major advertising campaign to recruit nurses and get former nurses to return. I can report that up to now—or rather, up to yesterday; there were probably more calls today—6,046 calls have been made in London in response to the advertising campaign; 840 came from nurses wanting to return to work in the NHS, and 91 such nurses have already returned. They are being further encouraged by the provision of free return-to-nursing courses. Those have proved to be a popular success, as I learned when I visited the Mayday hospital, Croydon to welcome a dozen nurses back to the NHS. They had been on a short three-week course to bring them up to date, which was geared to meet their family needs, such as by not clashing with school drop-off or pick-up times. Nearly everyone who had been on that short course had returned to nursing.

Of course, the Mayday has become more attractive by its having benefited from the recent opening of a new accident and emergency unit.
Many students of nursing and young nurses require good-quality secure accommodation that is near their place of work. Regrettably, much of that accommodation was sold off under the previous Government and a lot of what remains is in a deplorable condition. I am having talks with the hospital authorities concerned and the Housing Corporation in an attempt to turn back the tide and provide somewhere decent, affordable and convenient for nurses to live, because a modern work force need somewhere safe and decent to live.

Mr. Simon Hughes: I agree with the Secretary of State's last point. On the nurses' pay issue, I have learned in the past few weeks that, although the pay award was very welcome, many nurses were frustrated to discover that they had not received the increase in their April pay packets. I do not want to be over-critical at this stage, but can the Secretary of State address the problem whereby pay awards announced with great flourish in January and February do not come through before September? That is a disgraceful situation, and many nurses feel badly let down.

Mr. Dobson: Most nurses have received their pay increases and, as far as I know, no one will be kept waiting until September. If anyone is kept waiting that long, the chief executives of the trusts concerned should receive their P45s and insurance cards in September. Like every other hon. Member, I believe that it is quite unacceptable to keep people hanging around in that way.

Mr. Alan Duncan: The right hon. Gentleman always wants to sack people.

Mr. Dobson: If the people in charge of large organisations that depend on many loyal staff cannot sort out their pay systems for five, six or seven months, I think it is wholly appropriate to contemplate doing without their incompetent services.

Mr. Duncan: I also said that the Secretary of State should give the trusts the money to pay for the awards in full. According to many trusts, the money that they have received does not cover the awards that were announced in the House.

Mr. Dobson: Those chief executives should be more careful about what they say because virtually the whole of the increase was met—

Mr. Duncan: Virtually.

Mr. Dobson: Yes, virtually. I try to tell the truth in the House and I am rather careful about what I say. Virtually all the increase was met from the allocations that the trusts had already received and knew about. The additional sums were found, as we intended, from the modernisation fund. Very few trusts have had to find much money. That is in marked contrast with the previous Government's total refusal to fund any pay increases in some cases. The previous Government provided no additional resources in some years to meet trusts' pay obligations.


Now that the pressure for internal competition is out of the way, a group of 35 inner-London trusts have done the sensible thing and have got together to promote better recruitment arrangements and to make working in London more attractive. They intend that work to cover not just nurses and midwives, but pharmacists and other groups as well.
At my instigation, trusts are now pursuing rigorous anti-violence policies: logging incidents, liaising with police, changing working practices, issuing staff with personal alarms, installing closed circuit television and changing the layout of buildings. I am told by those concerned that the new policy has already brought benefits in the modernised A and E departments at the King's College and Mayday hospitals. Our commitment to renew and modernise all A and E departments will deliver similar improvements in every part of the capital.
London is a multicultural city and the ethnic origins of a quarter of its population are black or Asian. Some ethnic groups have special needs and London's NHS must cater better for those needs, which include tackling heart disease in the Asian population, stroke prevention in the Caribbean population, and the take-up of breast and cervical screening among Asian women.
Many people from ethnic minorities have also felt excluded from the decision-making processes of the NHS. At the general election, we promised to make NHS boards more representative of the communities that they serve. Since we came to office, 53 per cent. of our appointments in London have been women and 24 per cent. have come from an ethnic minority background. The previous Government had a target that every health authority or trust with an ethnic minority population of 10 per cent. or more should comprise board members from an ethnic minority. That was all very well as a target, but they did not get around to achieving it.
Sixteen trusts and health authorities in London serving areas with more than 10 per cent. ethnic minority populations did not meet that target before the general election. Now all but three of them do. In total, 46 NHS boards in London have one ethnic minority member; 17 boards have two such members; and three boards have three. [Interruption.], I did not catch what the right hon. Member for Kensington and Chelsea (Mr. Clark) said.

Mr. Alan Clark: I was going to suggest that all the white middle-class males in the catchment area be employed as cleaners.

Mr. Dobson: On the basis of that comment, I shall not make the right hon. Gentleman the principal recruiting officer for the NHS in London.
My actions should help to make sure that proper attention is paid to rooting out institutional racism faced by patients and staff, but I emphasise that this is a task for everybody, not a lone member from an ethnic group who serves on a board.
That brings me to the wider question of tackling inequalities in health, not only through targeted effort by the NHS, but by using every instrument at the Government's disposal. Poor people are ill more often and die sooner. I have been stating that ever since I became an MP, and we have had further confirmation of the truth

of that in the past few days in reports revealing that strokes and cancer are more common and more harmful for people who are badly off. We all know the factors that systematically make poor people ill: unemployment, low pay, poor housing, crime and disorder and a polluted environment. This Government are taking concerted action to tackle those problems.
There are now 143,000 more people in work in Greater London than there were two years ago, when we were elected; 36,000 young people have started the new deal, and 6,800 have already got jobs. There is still a long way to go, but our proposals are working despite the opposition of Tories and Liberals who preferred to defend the windfall profits of the utilities rather than invest in our young people and the long-term unemployed. Getting a job will improve the health of those people. The figures reveal that, if a middle-aged man loses his job, that doubles his chances of dying in the next five years, and the group that has suffered the highest increase in mortality is made up of young men who are out of work.
The introduction of the national minimum wage—I am inordinately proud to be a member of the Government who introduced that measure—has benefited 116,000 people in work in London by putting more money in their pockets and handbags. The working families tax credit, which guarantees a minimum full-time pay of £200 a week for a family with children will benefit 125,000 families in London.
As far as I know, all those measures were opposed by the Tories and some were opposed by the Liberal Democrats. They will all put money into the pockets of the worst-off and thereby improve their health and that of their families, and that is one of our main reasons for introducing them.

Mr. Duncan: Setting aside any arguments about whether the minimum wage is good or bad, will the Secretary of State, for the information of the House, advise us how much the implementation of the minimum wage has cost the national health service in London?

Mr. Dobson: For an organisation that will be spending £40 billion this year, the answer is next to nothing, and certainly not the stupid, harum-scarum sums of £500 million that were quoted by Tory Members who have held the job that I now have. They gave those "estimates", as they called them, because they wanted to put people off supporting the minimum wage and because they were too idle and feckless to have collected any information on the levels of pay in the health service. They apparently gloried in the thought that they had been presiding over a health service in which tens of thousands of hard-working staff were so badly paid that their pay would be improved by the introduction of a national minimum wage. The impact of the measure is minimal.

Mr. Eric Forth: As the Secretary of State has been so typically robust about comments that my colleagues have made in the past, will he now demonstrate his grasp of the subject by giving us the actual cost of implementing the minimum wage for the health service as a whole and the health service in London?

Mr. Dobson: The costs are minimal. [Horn. MEMBERS: "What is the figure?"' Below £10 million—not £500 million, which the fools on the Opposition Benches were quoting. The last estimate that I received of the costs of implementing the £3.60 minimum wage was below £10 million.

Mr. Duncan: Is that for London?

Mr. Dobson: No, that is for everywhere in the country. We have not broken down the figure. Because levels of pay in London are that bit higher, I doubt whether anyone in the NHS in London is earning less than £3.60 an hour. I emphasise that such information was not available to me when I first became Secretary of State because the Tories had deliberately stopped the collection of that data three years earlier. Indeed, it cost us £46,000 to carry out a survey to find out what the impact would be.

Mr. Duncan: If the cost to the NHS was less than £10 million overall, how can the right hon. Gentleman maintain that there was a problem of low pay beforehand?

Mr. Dobson: I was not saying that.

Mr. John Horam: What is the point of the minimum wage?

Mr. Dobson: If the hon. Gentleman asks the more than 2 million earners who are now getting a national minimum wage of £3.60 instead of £1.80, £2 or £2.30 an hour, which his well-paid little friends were paying them, he will find that plenty of people think that there are advantages to a national minimum wage. Practically every decent person in this country thinks so. Despite all the Tory propaganda, there was scarcely ever a time when less than three quarters of the people in this country believed that the national minimum wage was a bad idea. We have never thought that it would have much impact on the NHS. The Tories were estimating that it would cost £500 million, which shows how stupid and ill-informed they were about that aspect of the NHS for which they were responsible.
In London, 2.6 million employees will benefit from the cut in national insurance contributions, and the new 10p starting rate of income tax will halve the tax bill for 170,000 Londoners. Putting more money into their handbags and pockets will improve their health.
Record increases in child benefit will raise the living standards of the worst-off families with children. The sure start programme, over which my right hon. Friend the Minister for Public Health is presiding, will bring together early education, health services and family support for families when they need it—with more than £450 million over the next three years. Some of the pilot schemes will be in London. There will be one in Camden and, I believe, the other will be in Southwark. There seems to be some strange coincidence between the location of those pilots and the places represented by today's Front-Bench spokesmen.
New improvements in pensions and the £100 million winter payment fund will benefit 1.2 million London pensioners. Their finances and health will also benefit from the abolition of the charge for eye tests for over

60-year-olds, which the mean-minded Tories were happy to introduce because they wanted to start charging for everything in the NHS.
As part of our efforts to provide people with somewhere decent to live, the Government are investing £145 million to reduce the number of people sleeping rough. The bulk of that money will be spent in London, which will certainly improve the health of the people concerned. We are also investing more than £5 billion a year on building new homes and renovating old ones; £390 million from the capital receipts initiative will be invested this year in new and better homes for Londoners, which will therefore improve their health.
It would be silly to try to pretend that everything is fine with London's health services, and that improvements can be made immediately, but it is certainly true that things are improving and will continue to improve. New hospitals are being built, old hospitals are being modernised, staff pay and conditions are being improved, new and better ways of working are being introduced, the quality of treatment and care is being raised and more and more patients are being treated.
In March, we published a modernisation plan for the NHS in London, which describes the targets that the Government are setting—no longer keeping them a closely guarded secret, but spelling them out, so that Londoners know what they are and can judge whether they have been met. I am confident that they will be met and that it will be largely because of the commitment, skill and professionalism of the NHS staff working in London, which, as I said at the beginning, were so amply demonstrated by their brilliant response to the three outrages in Brixton, Brick lane and Soho over the past three weeks. We owe them a great deal and we are determined to provide them with modern buildings, modern equipment and modern ways of working so that they can deliver a service to a standard to which they have always aspired.

Mr. Alan Duncan: May I associate myself and my right hon. and hon. Friends with what the Secretary of State said in some detail—it needed that detail—in praise of those who work in the national health service and their response to the three outrageous nail bomb attacks in London over the past few weeks? No praise can be too high. Lives have been saved and people have been treated quickly and well. Their response to what happened in Brixton, Brick lane and Soho was admirable. I am sure that the Secretary of State joins me in condemning the contemptible nature of those attacks, which were all the more contemptible for being targeted at minorities.
The praise given to health service personnel today is the sort of praise that hon. Members want to give pretty well all the time because, by and large, the health service is successful because of the people who work in it. It is the people who make it. It is their dedicated nature that makes it the success that it is. It is what they do that makes the health service something of which to be proud.
In London and every other part of the country, things are not perfect. As politicians, we have a grave duty to make sure that debate on this subject is of the highest standard possible. If we get the debate wrong and we are irresponsible in our discussions, quite literally, it can cost lives.


The health service is a massive enterprise, probably one of the largest single employers in the world. It has a massive budget and a massive task. It has a duty of care which perhaps no other organisation has to meet on such a large scale. Therefore, it behoves us to treat it not with the political licence with which so many other topics are treated, but with a grave responsibility and deeper thought than many are prepared to give.
Conservative Members are trying to do that. We are trying to recognise that this is a modern world where wants are taking over from needs and people expect things to be delivered. It is a consumer world where people expect their wants to be met as well as their needs and, clearly, the NHS will not be able to do it all. It has never been able to. If our starting point for debate is a denial of that basic fundamental point, which every cabbie in the street will say is common sense, we will not be treating this matter with the responsibility it deserves.
I want to make it clear where we are coming from. We admit that rationing exists and that it always has. We admit that there is a shortfall between what the NHS can deliver and what its resources can allow it to deliver. Our basic position is simple—we recognise that the NHS cannot do it all.

Mr. Mike Gapes: What does the hon. Gentleman think that the national health service should not provide, and for what should people be forced to pay?

Mr. Duncan: The Government should consider exactly that in recognising that the national health service cannot do it all. There is no prospect—no chance, even—of starting a sensible discussion on the national health service's limitations and capabilities without first admitting that the health service cannot do it all. As I said the other week, in a lecture, if the national health service cannot do it all, it is immoral for anyone to stand up and say that it should—unless they are prepared to say clearly from where the resources will come.
Our vision of health care in Britain is for the overall health care sector to be expanded when possible. In other countries, a private sector larger than ours works in harmony with the public sector. We want the United Kingdom to develop such a mutually supportive private-public mix. Those who say that the national health service can and should do it all are only trapping us in an unreal world in which patients will suffer.
The Opposition's position on the national health service is clear, whereas the Government, who are responsible for the health service, have not made their position clear. The Government gained office by stirring up grievance and campaigning against almost every hospital closure. In some cases, they won a seat in this place by promising that they would keep a hospital open. They also continue to enjoy blaming the previous Government for every possible problem in the national health service, although they refuse to come to terms with the basic fact that the national health service cannot do it all.
One has only to consider the Secretary of State's comments on the minimum wage to realise that the Government's campaign promises do not marry with their statements in government. The Opposition's task is to

ensure that the Government are held to account, so that their actions since being elected to government may be judged by their statements before the general election.
There is rationing in London, as there is in the whole country. The Secretary of State attended the London school of economics—albeit at a time when it was teaching some pretty funny things—and studied economics. He should therefore know the definition of rationing—[Interruption.] I hear him pleading guilty, and I join him in that verdict.
There is rationing. By what definition is there not rationing in the national health service? If there is a limit to what the national health service can do, if everything that is demanded is not supplied, and if a monopoly supplier is deciding for patients what they can or cannot have, what is it, if not rationing?
I ask the Secretary of State—who, even on Tuesday, denied that there was rationing—and the Minister for Public Health, who answered no when asked point-blank whether there was rationing in the health service, to define rationing. If the national health service is determining what people can or cannot have in the face of scarce resources, what is it, if not rationing?

Mr. Dobson: By the normal definition of rationing, the only rationing of health care in the United Kingdom is occurring in some parts of the private sector, which provide insurance cover only up to a certain sum, after which people must pay for care themselves. That is rationing. Every definition of rationing—I refer the hon. Gentleman to the "Oxford English Dictionary"—

Mr. Duncan: Answer the question.

Mr. Dobson: I refer the hon. Gentleman to the "Oxford English Dictionary", as it might be a good idea for him to base his arguments on something sound. All dictionary definitions of rationing describe limits to what is available to an individual—but that situation does not apply in the national health service at all. Everyone knows that there are limits to available resources. However, suggesting that we have rationing in the national health service is like saying that, because there are no more seats on the jumbo jet that one wanted to go on to New York, for example, flights are being rationed. No one thinks that that is a sensible definition of rationing.

Mr. Duncan: That is an extraordinary statement. The Secretary of State has just said that there are no limits to what an individual can get on the national health service. If that is his defence against my charge that there is rationing, he is in a very peculiar position and his comments will not bear scrutiny.
Let us consider daily life in the national health service in London and throughout the country. Waiting lists are a form of rationing. Patients want and need treatment, but they cannot have it yet. They have to wait. It was the same during the war when there was a shortage of food. People could not have their sausages until new supplies came in. Delays for treatment are a form of rationing.
The situation is not even improving, as the Secretary of State claims. It remains as bad as ever. For every fall in the waiting list that he publishes, he knows that there is a pretty well equal rise in the number of people trying to get on the waiting list. We have continuous, unimproved


rationing by making people wait not just to get the treatment that they need, but—this is worse—to get the diagnosis that they need to work out whether they need treatment.

Mr. Dobson: The hon. Gentleman apparently sees a parallel between the national health service and wartime rationing of food. Under wartime rationing, people got a specific amount of bacon a week and nobody got more. That is rationing. We do not have that in the national health service. We do not say, "You can have £50 of treatment and then that's your lot." That would be rationing.

Mr. Duncan: The situation is even worse. Such is rationing in the national health service that someone who needs beta interferon for multiple sclerosis might not get it at all, depending on where they live. Some people get it and others do not. That is another form of rationing.
If even those logical arguments have not persuaded the Secretary of State that rationing exists and that he has yet to treat this massive issue with the honesty that it deserves, let me refer to Viagra.

Mr. Roger Casale: rose—

Mr. Duncan: Before I do so, I shall give way to the hon. Member for Wimbledon (Mr. Casale).

Mr. Casale: Does the hon. Gentleman accept that the introduction of nursery vouchers was a form of rationing? Is his party proposing something similar for access to the national health service?

Mr. Duncan: I am trying to explain to the Secretary of State that there is a difference between the resources put into the health service and the demand that is put on it, but he seems impervious to that point. The shortfall leads to rationing, but he is not prepared to admit to that form of rationing.
Viagra is the perfect example to fit in with the Secretary of State's narrow and peculiar definition. There is a lawsuit under way about the manner in which the Secretary of State has taken a decision about Viagra and I would not dream of straying into any details that might be deemed sub judice. The more general point, which is evident from the statements that he has made in the House and to the press, is that he intends to ration Viagra. It will not be freely available on prescription in the national health service, even if GPs, using their clinical judgment, assess a patient to be in need of the drug. Instead, the Secretary of State intends to restrict it to the narrowest possible form of availability, thereby paradoxically forcing anyone else who might otherwise be prescribed it within the national health service into the private sector—which the Secretary of State so loathes and reviles—where they have to pay double or even more.
So we have a new drug which can do a lot of good to people who clearly need it, which is recognised by clinicians throughout the health service and which will not be available from the national health service. Its availability is restricted. That is rationing and it applies in London and everywhere else. We need some transparency as to the rationale behind the Secretary of State's decision about what is available on the national health service, what is rationed and what is not available at all.
Unless we have a realistic, grown-up, responsible debate about what the health service can and cannot do, London will suffer, the future of health service care throughout the country will suffer and the Secretary of State will not go down in history as someone who has met the responsibilities that have been entrusted to him. The debate has become puerile and deceitful. It has become a nasty form of politics of which the Secretary of State cannot be proud.
Let me turn to deficits in London. The Secretary of State has paraded no end of generosity about the spending round. He came to office two years ago—that is, two financial years. If he thought there was a great problem, he has had time enough to sort it out. However, a recent article in the Health Service Journal reported that London trusts and health authorities have a deficit of £74.74 million. That figure does not include mental health trusts or Lambeth, Southwark and Lewisham health authorities. It is estimated that the total deficit in London is probably in excess of —100 million. I am not sure whether the Secretary of State is snoozing or smiling, but he does not seem to want to address the fact that —100 million is a large deficit, which he used to criticise in opposition. Given what he said in opposition and what he claims to be doing in government, what does he propose to do about the —100 million deficit in our health service?
How can the Secretary of State reconcile everything that his party campaigned for in opposition with what has subsequently happened in respect of closures? When we were in government, we had the honesty to admit that, as old buildings decay and patterns of health service demand change and the requirements of technology and population shift, some hospitals will close, others will provide different services, others will take on different responsibilities and new hospitals will have to be built. That is a fair-minded, sensible view of how a developing health service should operate. However, that was not Labour's opinion in opposition. According to Labour, every closure was bad, every change was bad and no hospital was doing enough. Some Labour Members even had the deceit to put out election literature promising that certain wards or hospitals would remain open in order to grub for votes, only to collude with the new Government on their subsequent closure. Does the Secretary of State have any qualms about that? Is he worried that his reputation might sink? He seems impervious to accusations that such deceitful politics harm the reputation of his own party and the health service.

Mr. Dobson: Instead of making generalised smears, will the hon. Gentleman be specific?

Mr. Duncan: Barnet, Edgware and Roehampton are all examples. Indeed, I shall be more specific. The Turnberg report said a great deal of sensible things, but it does not marry with what Labour said in opposition. The full list of closures includes the accident and emergency department at Guy's and a reduction in bed capacity there; the closure of Greenwich hospital; loss of facilities to St. George's at Atkinson Morley's hospital and the closure of Queen Mary's hospital at Roehampton—another one that they said they would not shut. Queen Charlotte's is another example—I could go on, but first let me turn to Bart's.

Mr. Dobson: Has it not registered with the hon. Gentleman that we are building a new hospital at


Greenwich, and that the movement of Queen Charlotte's hospital to the Hammersmith hospital was—as far as I know—welcomed by virtually everybody involved, including the Labour party when we were in opposition? The hon. Gentleman may take as an example amalgamations of hospitals and closures. Four hospitals will go into the new University College hospital in my constituency; the Elizabeth Garrett Anderson hospital, University College hospital, the Middlesex hospital and the Hospital for Tropical Diseases. I supported that through thick and thin in opposition, and I continue to do so. I do not regard it as four closures; I regard it as a promise to build a new hospital.

Mr. Duncan: The Secretary of State tries hard, but he knows that Labour's campaign promise was that the Edgware and Roehampton hospitals would stay open.

Mr. Dobson: They are.

Mr. Duncan: The accident and emergency departments are shut. Does the Secretary of State admit that Labour in opposition promised that those facilities would remain open, but shut them when it got into government? Will the Secretary of State admit that? He will not.

Ms Joan Ryan: When the last Government were ensuring the closure of Edgware district general hospital, I was a member of Barnet council. That council—along with the Labour party locally, the Labour Opposition in this House and the entire local population—fought tooth and nail to keep the hospital open. Your Government did everything but close the door. You ran it down—

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. It was not my Government; the hon. Lady should refer to the hon. Gentleman.

Mr. Duncan: As the House well knows, the Government have it in their power to keep open hospitals that they said they would shut. They did not, but that is how they got into office.

Mr. Tony McNulty: I am sure that the hon. Gentleman—who is an honest man, filled with integrity—would not want to mislead the House. The Edgware general hospital accident and emergency facility closed on 1 April 1997—not after the election. Will he correct his inaccuracy?

Mr. Duncan: The hon. Gentleman should look at the election literature of his colleagues. He will realise that it does not stand up to scrutiny; nor does what the Government have done subsequently on Bart's.

Mr. McNulty: On a point of order, Mr. Deputy Speaker. Is it in order for the hon. Gentleman, however inadvertently, to mislead the House and not correct his inaccuracy?

Mr. Deputy Speaker: These are matters of debate. [HON. MEMBERS: "These are the facts."] These are issues in the debate. Obviously, all right hon. and hon. Members

should seek to make as accurate statements as they can to the House. May I suggest that an air of calmness should descend upon the debate?

Mr. Duncan: Perhaps I can ask the Secretary of State a specific question. This morning, 1 was given a copy of a letter sent to the Prime Minister by the Save Bart's campaign.

Mr. Dobson: When?

Mr. Duncan: This morning.

Mr. Dobson: No, when was it sent?

Mr. Deputy Speaker: Order. I just suggested that the debate was starting to become less ordered than it should be. Sedentary comments from Front or Back Benchers are not helpful.

Mr. Duncan: I was given the letter this morning, and I would welcome the Secretary of State's denial if what is in it is untrue. In the letter to the Prime Minister, the Save Bart's campaign said that plans were reportedly in preparation for Bart's renowned specialist expertise not to be concentrated at Bart's, but to be fragmented between Bart's and the Royal London hospital. The letter suggests that Bart's will provide a limited range of cancer and cardiac services only, and that that negates the Secretary of State's earlier decision. Does the Secretary of State deny that those suspicions are accurate, or not?

Mr. Dobson: We are committed—the Prime Minister backs that commitment—to having a major cardiac and cancer centre at Bart's, and we will. That will be delivered, as I said in my speech. The share between Bart's and the Royal London of cardiac services has been agreed to the satisfaction of all concerned, including the clinicians at Bart's. I hope that we will be able to reach the same conclusion about cancer treatment shortly. It will be delivered.

Mr. Duncan: I am grateful for that assurance. I hope that subsequent events will put the concerns of supporters of Bart's at rest. They are deeply concerned about the Royal Hospitals trust timetable for what is to happen over the next months and years. We will monitor events closely to find out whether their suspicions are founded. I know that the Secretary of State chooses his words carefully, but I hope that the suspicions expressed in the letter are unfounded.

Mr. Dobson: Let us get it on the record that the hon. Gentleman's Government—not yours, Mr. Deputy Speaker—intended to close Bart's. We will keep it open and turn it into a major cancer and cardiac centre. That is what we said we would do, and we will deliver.

Mr. Duncan: Let us hope so. I cannot understand, then, why people in the Save Bart's campaign are so upset. They clearly know something that the Secretary of State does not.
My right hon. Friend the Leader of the Opposition yesterday asked the Prime Minister specific questions about what the Government were doing in moving


amendments to European Union directives on junior doctors' hours. We did not get a straight answer. I have here a document addressed to the general secretariat of the Council. It says:
The UK delegation is proposing the following text
on doctors in training, and it includes the figure of 65 hours a week as the maximum. That affects some of the most significant hospitals in London, such as St. Thomas's across the river.
Junior doctors' hours are crucial. Why have the Government proposed that they should work 65 hours a week? I invite the Secretary of State to explain why they have done that, if, as he says—and I know that he is honest—they have no intention of ever increasing the figure beyond 56 hours? He refuses to answer. We have him pinned down.

Mr. Dobson: rose—

Mr. Duncan: Aha!

Mr. Dobson: The previous Government came to an agreement, a new deal, with the junior doctors, in which 56 hours was to be the target. When we came to office, 20 per cent. of doctors were working longer than that; the figure has been reduced to 15 per cent. and we intend to continue to reduce it. The proposition originally in the European Union directive would have been more restrictive than we thought sensible. We are taking part in negotiations and we believe, as I said in the House on Tuesday, that at the end of those negotiations we will have a sensible directive that will meet the needs of our junior doctors.
As I said on Tuesday, and as the BBC seems incapable of understanding, we want to get the junior doctors' hours down—that is what we will do—and we have no intention of increasing them, despite all the lurid headlines from the hon. Gentleman and his little friend who is not here today.

Mr. Duncan: We have become very familiar with that sort of response from the Secretary of State. Whenever he has his back to the wall, he either blames the BBC or says that someone in the national health service should be sacked. I have negotiated a few things in my time, but I cannot understand why, if the Government are aiming for 56 hours, they should table a proposal for 65. If anyone is brainy enough to explain how that can be good negotiating and will lead to what the Secretary of State says he wants, when the presidency itself has had to propose 56 hours, perhaps they can enlighten the House, because I am blowed if I can work it out.
Will the Secretary of State correct what he said on Tuesday? He said:
Children, pregnant women, nursing mothers and people on low incomes have always been eligible for free dental checks and sight tests."—[Official Report, 4 May 1999; Vol. 330, c. 689.]
Pregnant women and nursing mothers are not eligible for free sight tests. He does not seem to know that. What he said was totally inaccurate, and I hope that he will have the decency to correct it.

Mr. Dobson: If I said sight tests, I said it inadvertently. I am perfectly aware that it is dental checks that pregnant women and nursing mothers are entitled to. If the two got stuck together in one sentence, I duly apologise.

Mr. Forth: A rare event.

Mr. Duncan: I thank the Secretary of State for that apology, which is indeed a rare event. We have to be

persistent in opposition and try, by degrees, to bring him and his ministerial team down to a level where they will engage in serious debate and be accountable for what they say in the House, rather than continuing to distort so much of their stance on the health service.

Mr. McNulty: The hon. Gentleman said at the start of his speech that he wanted us to have a grown-up and mature debate on the health service in London. When is he going to start it?

Mr. Duncan: I will be happy to send the hon. Gentleman a copy of my lecture, and I look forward to a sensible critique.

Mr. Gapes: Will the hon. Gentleman give way?

Mr. Duncan: To do so seems like a hopeless way to raise the tone of the debate, but I will.

Mr. Gapes: While the hon. Gentleman is sending out copies of his lecture, will he send out extracts of his book containing the chapter that was in the original version but left out of the reprinted edition?

Mr. Duncan: That rather proves my point.
There are clearly problems in the London ambulance service, and I hope that the Minister will address them in detail when she winds up. We all recognise that national health service staff work very hard but, as I try to argue day in, day out, they are hard pressed and overstretched and are being asked to deliver far more than should be expected of any normal human being, especially on straitened resources. That is certainly the case in the London ambulance service.
The Evening Standard last week carried a large article on the state of the ambulance service, claiming that morale is plunging, that there is a growing staff shortage—not an inherited one—and that sickness and absenteeism are on the increase. It appears that there has been a sharp increase in response times and new figures show that the service is struggling. What steps are being taken to remedy that? It is important to keep response times to a minimum and we need to know what the Government intend to do.
I always try to give credit where credit is due. There was also a survey in the Evening Standard on people's views on GPs in London. By and large, the views were highly favourable, and we should congratulate the GPs—the family doctors—on that. That will change, however, if the Government continue to impose on family doctors structures in the primary care groups with which they are not happy.
What flexibility will be introduced in the way in which primary care groups can be changed? At the moment, doctors are forced into groups, often against their will. The survey shows that most people are happy with their GP, but that people especially like it when their GP is a single practitioner and do not necessarily want to go to a group. How do the Government intend to ensure that satisfaction ratings continue to be high? Moreover, how does the Minister respond to the accusation by the British


Dental Association this week that it is increasingly difficult to find a national health service dentist in London?

Mr. Gareth R. Thomas: How does the hon. Gentleman think that Londoners will gain a health benefit from his plan to introduce charges for visiting GPs?

Mr. Duncan: As neither I nor any other Conservative Member has said anything about that, I suggest that the hon. Gentleman goes away and does a bit of research.
The health service in London is a massive endeavour. Like the health service everywhere else in the country, it is doing its best on limited resources—and, as elsewhere in the country, it requires a vision for future health care, which it is not getting from the Government. The Opposition congratulate all those who work in the health service in London, but we look forward to a debate that will go beyond mere political battling and look to health provision for the benefit of future patients both inside and outside the public sector.

Mr. Tony Colman: Thank you for calling me early in the debate, Mr. Deputy Speaker, so that I can correct some of the extraordinary statements made by the hon. Member for Rutland and Melton (Mr. Duncan). He started his speech saying that we, as politicians, should not use political licence when we talk about the national health service, but hon. Members on both sides of the House should condemn what he said, especially in the later stages of his speech, because that is exactly what he did.
First, I need to put the record straight about Queen Mary's hospital, Roehampton, so I remind the House what happened before 1 was elected to represent Putney in May 1997. The decision on the transfer of services was taken in December 1996, and supported by Tory Wandsworth council, by the previous Tory Member for Putney, David Mellor, and by the Tory Government.
The changes, which took place in April 1997, a month before I was elected, involved the transfer out of acute surgery, orthopaedics and paediatric and maternity services, and the downgrading of the accident and emergency department to a minor injuries unit. The services were largely transferred to Kingston, but the previous Government had made no plans for their reception there. There were no additional wards or beds, and no additional help for the A and E department, so there was chaos. That was what I found when I became the Member of Parliament for Putney.
The Turnberg report mentioned the piecemeal erosion of services at Queen Mary's hospital, which had been going on for many years before the decision was made in December 1996, and utterly condemned it. It offered a vision of a new community hospital with a rapid diagnostic unit on the Queen Mary's hospital site, and I was pleased to hear the Secretary of State confirm his commitment to that hospital in his opening speech. I look forward to the business case for it going to the region, and then to Ministers this autumn.
I note that, in the report on what happened in the year since the Turnberg report was published, there is a commitment of £25 million for the development of that new community hospital. I remind hon. Members that the existing hospital dates from the early 1920s, and many of its buildings are converted Nissen huts. That is a good example of the way in which the health service had to patch and mend for so many years, especially under the Conservative Government. An appalling situation has been allowed to continue for too long, and my constituents and I look forward to the building of a new community hospital under a Labour Government.

Mr. Edward Davey: The hon. Gentleman said that services had been transferred from Queen Mary's to Kingston hospital in recent years. I know that he was recently a patient at Kingston hospital, so can he confirm that the transfer of services put great pressure on that hospital, and that it needs backing in the form of new capital and extra resources to meet the transferred demand?

Mr. Colman: I entirely support everything that the hon. Gentleman has said, and I shall deal with that subject later.
Secondly, I shall remind the House of what is happening in the interim, while we are waiting for the new community hospital to be built. A newly refurbished out-patients unit was opened on 27 April by Chris Patten, the former chairman of the Conservative party, who is now a resident of Barnes. The choice of Chris Patten was a cross-party move which I strongly supported.
One hundred consultants continue to work in the out-patients clinics at Queen Mary's, and the rapid diagnostic packages of care are developing. Streamlined procedures for breast care, cardiology, dyspepsia and thyroid care are already in place. Furthermore, at a cost of £924,000, services for out-patients and the elderly that were previously provided at Putney hospital and Barnes day hospital, in outmoded wards, will be transferred to the Queen Mary's hospital site this summer.
I make a particular plea for the continuing use of the Putney hospital site when it becomes vacant. It should remain available for health care purposes, and I especially endorse the bid being made by Abbeyfield nursing homes for housing for elderly people on the site.
As part of the funding package for the new community hospital at Queen Mary's, there is a proposal that land not needed and therefore released—the hospital now sprawls over a large area, so the new hospital will not need the whole site—should be used for the relocation of Whitelands college, which is part of Roehampton institute and the university of Surrey at Roehampton. That will ensure that all the constituent colleges can be on the same site.
One of the services on the new Queen Mary's site will be a healthy living centre, for which a bid will be made in the next round. I also endorse the services provided at the cancer support centre in Wandsworth, which now operates in not totally suitable premises at the Battersea Methodist church mission hall, but has none the less been supported by the local community health trust and the health authority as a centre of excellence for the support of cancer sufferers.
I welcome the introduction of NHS Direct, which is now available for my constituents, and others in south-west London. As the hon. Member for Kingston and


Surbiton (Mr. Davey) said, although some went to St. George's, the vast majority of the acute services for my constituents were transferred to Kingston hospital in April 1997.
The present Government are having to pick up the pieces of the Tory Government's failed policies, and they built additional wards and provided extra beds in the Roehampton wing of Kingston hospital, which were opened in September 1998—just in time for me to occupy one of the beds the following November, and see for myself the great difficulties that the hospital is having in the A and E department, where I waited for eight hours to be treated. I strongly urge the Minister to take forward the current bid for a £2 million renovation and extension of the existing A and E at Kingston.
I understand that, in the past few days, the local trust has withdrawn the bid, because it foresees some major rebuilding that could cost up to £10 million. However, I am keen to ensure that, from this autumn, my constituents—including me, if I suffer again — do not have to wait as long as I, and they, have had to wait in the past.

Mr. Davey: I spoke to the chief executive of Kingston hospital today to clarify what he seeks from the region for his A and E department. He is suggesting several options, including renovation, but also including new build. It will be for the region to decide, but the business case has not been withdrawn; several options are being suggested and are now being properly costed. I think that the hon. Gentleman would agree that that is the proper business approach to making that important investment at Kingston hospital.

Mr. Colman: I thank the hon. Gentleman for that additional information and I am sure that he would agree that the site needs an immediate improvement this autumn. I would be concerned by any delay.
My third point about the situation in Kingston is the fact that many of the nurses on the acute wards who were transferred in April 1997 subsequently left, for a variety of reasons, but among the key ones was the unavailability of creche facilities. A bid is being made for a new 48-place day nursery on the Kingston site and I ask the Minister to support it. Another problem in the transfer of the nurses was the move from an inner-London weighting area to an outer-London weighting area. Everything must be done to ensure that nurses do not leave. It is not acceptable to recruit from the Philippines, however good those nurses are, because nurses who have previously worked at Queen Mary's cannot transfer, because of the lack of creche facilities or the diminution in their salaries for moving all of three miles.
My fourth point is the need to ensure that communication links between Kingston hospital and the Queen Mary's hospital sites are improved. At the moment, those links hardly exist and they are crucial to ensuring the development of the rapid diagnostic unit. Further communication links are needed between the two primary care groups that operate from the Queen Mary's site—the Richmond PCG, headed by Dr. Ian Johnson, and the Putney Roehampton PCG, under Dr. Sarah North—to ensure a joined-up national health service in south-west London.
I also endorse the bid from the chairman of the Richmond PCG, Dr. Ian Johnson, for GP beds on a site at Queen Mary's. Additionally, I endorse the work by the Pathfinder Trust on additional mental health beds as part of the new community hospital at Queen Mary's.
I especially wish to endorse the thrust of the Turnberg report about taking a local and regional approach. The report talked of a health service for London governed by a single bureaucracy, in order to leave behind the North and South Thames regions, but it also mentioned five sectors that would result in a sub-regional approach. I also endorse the South West London community trust, which came into being in the past month by bringing together the Richmond, Twickenham and Roehampton trust, the Wandsworth community health trust and the Merton and Sutton community trust. The new trust will minimise bureaucracy, and I especially endorse the work of Dr. Liz Nelson, the outgoing chair of the Richmond, Twickenham and Roehampton trust and the new chair of the south-west London community trust, and of Lucy Hadfield, the new chief executive. As part of the move to sectoralisation, I hope to see Merton, Sutton and Wandsworth health authority and the Kingston and Richmond health authority coming together, so that we have the primary care groups on a constituency level and a more over-arching approach on a sub-regional basis to deal with contracting.
The Turnberg report clearly stated in its criticism of the previous Government's delivery of health care services for south-west London that there was a need for a clear, unambiguous commitment to fulfil a credible plan. I have described such a plan today. The previous Government left health care in south-west London floundering: this Government, in modernising London's health service, have a clear vision that is being realised.

Mr. Simon Hughes: Like the Secretary of State and the hon. Member for Rutland and Melton (Mr. Duncan), I wish to begin by paying tribute to the health service in London for its prompt, skilled and dedicated work in recent weeks. The excellent and timely work of the ambulance service and the paramedics was followed by the skill and commitment shown by people who worked for hours and hours in operating theatres to try to save the lives of those who had been attacked by the deranged, and to try to ensure that their horrific injuries were minimised and the violation of their integrity as human beings was reduced. The work continues, because people are still in intensive care battling for their lives, and it is a tribute to the best principles of the health service. Those staff do huge credit to their professions.
Hon. Members present for the debate are almost entirely Londoners, because we are exempt from the democratic activities that affect the rest of the country. I said almost entirely, because the hon. Member for Rutland and Melton is a notable exception. There are elections in his part of the world, but there are no Tory candidates.

Mr. Duncan: Forward planning.

Mr. Hughes: If that is forward planning by the Tory party, it must really be in difficulties. The hon. Gentleman is a welcome exception, but the rest of us are here because the Government's business managers wisely scheduled


this debate today. We welcome it, as we welcomed the Turnberg report. Sir Leslie and his colleagues did a good job and we are grateful to the Government for commissioning the report and for taking from it the guidelines for London's health service.
I welcome also the Government's agreement on the preparation and publication of progress reports on the health service in London. We have now seen the first of those reports and I hope that we have regular, annual reports. Those reports should not only address the Turnberg report and its recommendations—and examine how each is being implemented—but give us the statistics for the previous year, this year and the next year, so that we can make comparisons of simple matters, such as bed and staff numbers. I guess that the House will debate only one more such report, before the matter is handed over to the Greater London Authority, which will properly wish to consider the strategic plans for the health service in London.
Another useful background document, which has not been expressly mentioned so far in the debate, has been published since the last debate on London health. The Health of Londoners Project's report, on the public health of London, was compiled by all the health authorities and it is a valuable document from which much useful information can be gleaned. I commend those who worked on the document, especially the public health directors of the London health authorities, many of whom are eminent in their own right.
All our debates about what the NHS should do must be predicated on the actual state of health of Londoners. The public health document contains various facts about that which confirm how unequal our society is and how severe some of its health problems are. For example, the document reveals that one third of London's secondary school pupils are eligible for free school meals. That is a hugely high figure for the end of the 20th century. According to definitions that I did not devise, the number of London people living in poverty rose from 14 per cent. in 1983 to 24 per cent. in 1992. Some people are in a worse financial and social position than a decade ago.
As the Secretary of State noted, indicators of homelessness, of domestic violence, of the numbers of people out of work, of those claiming income support, and of the numbers of families in which no one is in work and 324,000 children belong to such families—all show the social context of the work of the NHS in London. People must have the best opportunity to achieve the best health. We can begin to understand the pressures when we discover that two thirds of the asylum seekers and refugees who come to Britain come to London.
The Government, and their predecessor, rightly tried to define public health priorities. Three of those priorities relate to premature deaths, and are hugely important in London. Those priorities are to reduce the number of deaths from cancer; to reduce the number of deaths from heart disease, strokes and related diseases, which in large part are activity-related; and to reduce the numbers of suicides, and therefore the incidence of the mental illness that leads to suicide.
Although cancer mortality rates for people under 65 are falling, in Greater London and elsewhere, my experience is that huge numbers die from cancer in London who,

with early detection and treatment, would have survived. A friend of mine died in that way last year, five or six weeks after first diagnosis. He left a teenage son, and his is one of the tragedies that all hon. Members would want to prevent.
Such problems are not outside our control. Politicians with the right social policies can resolve them. I hope that we are united in our determination to ensure that people's chances of surviving are improved. That is a bigger task in London than anywhere else in Britain. I pay tribute to the Government for having that commitment. I shall support them and work with them to deliver on it, although I shall also have a go at them when I think that they have got targets or priorities wrong, or when they do not deliver as they should. However, I hope that all hon. Members share the same goals and motivation.
I hope that Ministers will consult members of the Opposition parties—perhaps outside the House—to agree the figures and indicators used in annual reports. That would ensure a common basis for information. Debates such as this are often bedevilled by the political manipulation of statistics. Independently audited statistics—for example, about waiting lists, and so on—would ensure that we do not have to argue about their accuracy.
Three elements in the national targets require continued effort. The first is general health. We can reduce the number of people who become ill from circulatory diseases by reducing accidents, improving public transport and cutting air pollution. Above all, society should encourage people to exercise, walk and cycle, rather than be increasingly less active as they grow older.
Obesity and inactivity are bad for health, but increasingly evident. That is why it is important to try to cut out unnecessary car journeys, to encourage people to take their children to school on foot, and so on. If children are encouraged to walk or cycle to school, or if adults are encouraged to get to work on foot, or by bicycle or public transport, where possible, there is a direct effect on their chances of living longer. Such incentives, if got right, can lead to a huge reduction in death or illness rates.

Mr. Nicholas Winterton: I have followed the hon. Gentleman's speech with interest, and consider that he has made some very good points. He has mentioned people walking or using a bicycle rather than driving. Will he say how that can be brought about? I hope that he will not suggest compulsion, or that people should be dictated to, as I think that setting an example is a more appropriate approach.
Earlier in his speech, the hon. Gentleman mentioned the tragic case of a friend who died of cancer within five or six weeks of diagnosis. I hope that he is not suggesting that that person would have been saved if he had been screened earlier and the disease identified sooner. It sounds to me that that was a case of terminal cancer, and it would be grossly unfair to lay his friend's death at the door of the national health service.

Mr. Hughes: The hon. Gentleman is very experienced in these matters, and is right to raise those points. I agree about the need to use example rather than compulsion, but I also think that there is a place for incentives. My hon. Friend the Member for Sutton and Cheam (Mr. Burstow) was deputy leader of Sutton council when it introduced


an incentive to its work force to travel to work by bike rather than by car. That incentive was a travel allowance, and has become part of good practice. There are all sorts of other practical options, such as providing enough secure cycle racks for cycle users.
I do not blame the health service for the death of my friend. His name was Dave Clark: he was the editor of my local newspaper, and the Minister for Public Health, whose constituency includes Dulwich, knew him too. He died in Guy's hospital, which did a wonderful job on his behalf. However, although it is not possible to screen people at every moment throughout their lives, the chances of disease taking hold could be reduced if people checked their health more commonly, for instance by having their blood pressure checked at work regularly. My brother did not know that he suffered from high blood pressure. He had a stroke at work. It is not certain, but that stroke might have been prevented had there been a routine way of checking blood pressure at his workplace.
The second matter about which I want to speak is sexual health. One of the real challenges in London is to improve the sexual health of people, including young people, and to reduce unwanted and unintended teenage pregnancies. The health action zone in my part of the world has that specific intention, but there are worrying signs. The number of young women who become pregnant at a very early age is still very high, which indicates the need for proper sex education. Another worrying sign is the upturn in the incidence of HIV and similar conditions as a result of unsafe sexual practices.
In a capital city as cosmopolitan, varied and diverse as London, we must use public health promotion opportunities to tackle those problems head-on. Some people may find such methods of communication embarrassing, but more would find them effective.
Thirdly, the Turnberg committee was clear that London's mental health services are the highest of priorities. I welcome that clarity. The committee made two specific points in its recommendations. The first was that there must be minimum standards for mental health services, applicable across London. Those standards should cover maximum waits for appropriate residential care, the speed of response of community teams and the availability of 24-hour support services.
The Government have allocated some money for such services, but I hope that the Minister, when she replies to the debate, will say whether there is a target date by which facilities for people with mental health needs throughout the capital will be available on a 24-hour basis. Those people need to know that such a service does not close at 6 pm, but is available around the clock. There can be fatal consequences if such people are left to struggle on their own with their depression or with the pressures that they face.
The Turnberg committee also recommended that there must be intermediate care facilities with beds for recuperation, rehabilitation and respite care. For those who look after those who suffer mental illness, schizophrenia or depression, or for those who suffer it themselves, somewhere to go for a day or two can be necessary. People need to get away from the madding crowd to be able to recover in calmness. We need community beds as well as acute beds, the type of beds that many constituency hospitals used to have, but have been closed. I do not mean high-intensity or

high-dependency beds; I mean low-dependency beds which give an opportunity to get away and to seek asylum—in the proper sense—from the pressures of the capital.
On resources, the hon. Member for Rutland and Melton rightly talked of the deficit in the health service at the beginning of this financial year. The Chief Secretary to the Treasury said about a year ago, when he was Minister of State, Department of Health, that there should be no deficit this year. Yet Redbridge and Waltham Forest health authority starts the year with a deficit of £1 million; East London and the City has a small one; Kensington, Chelsea and Westminster has a deficit of £750,000; Croydon has one of £3.5 million; and Kingston and Richmond one of £2.75 million. After two years of Labour Government, London's health authorities are still in significant deficit.
That means that, at the start of the year, money must be found out of the budget intended for front-line services. Among the trusts, University College has a deficit of £3.5 million; Chelsea and Westminster, £3 million; St. Mary's, Paddington, £6 million; and Richmond, Twickenham and Roehampton, £4 million. Trusts and health authorities cannot manage and reduce such great sums if the funding system provides no money from the Treasury to pay them off and no other additional resources.

Ms Karen Buck: The hon. Gentleman mentioned St. Mary's hospital, Paddington. The current deficit there was discovered some months after the general election, having been in the system for years without anyone knowing. One can ask how that happened. Undoubtedly pressure was applied before the election to ensure that the scale of deficit was not public knowledge.

Mr. Hughes: I do not dissent from the apparently valid first point. However, I hope that the hon. Lady will agree that, no matter how deficits come about, when it comes to running a trust and delivering services at a place as important as St. Mary's, a deficit of that size requires someone to come to the rescue; otherwise, the trust is left simply paying off the overdraft rather than paying nurses or carrying out care.
Turnberg recommended a review of resource allocation funding. The Government's annual report adds that the advisory committee has concluded its work and changed the relevant formula. The changes look good, although I am not able to say whether they are enough. It would be useful if annual reports set out the cash effect of the changes. Who wins and who loses? Whether for health, transport or local authorities, the formula is often the key. If the formula is wrong, the service suffers badly.
Can the Minister tell us whether the weighted capital has been adjusted to reflect the burden of mental health need in London following the Turnberg recommendation? Turnberg said that more money was needed. If that has not yet happened, when will it?
London is under huge staffing pressure. The report tells me neither how many staff we have nor how many vacancies there are. I know that there are many vacancies for nurses, doctors, midwives, health visitors, health professionals and hospital ancillary staff. We are also losing general practitioners. We do not have enough of


them—many GPs are coming up to retirement age—and Turnberg recommended that something be done to recruit enough. London is short of dentists, and the report says nothing about what is being done to ensure access for everyone to an NHS dentist. We have lost many school nurses, and we do not have enough counsellors, an important part of the health service professional family.
Pay matters hugely. The hon. Member for Rutland and Melton rightly asked the question that I had asked the Health Secretary on Tuesday about NHS pay. It is no good the Health Secretary blaming the management of trusts and saying that they may receive their P45s if staff are not paid until September. Having announced the pay increase on 1 February, the Minister of State wrote to me on 4 May, saying:
The Advanced Letters promulgating the pay increases for 1999–2000 were issued to the National Health Service on 12 March 1999 for hospital doctors and dentists, and on 8 April 1999 for nursing staff, midwives, health visitors and professions allied to medicine."—[0fficial Report, 4 May 1999; Vol. 330, c. 361.]
If people were not told until 8 April that they could pay the money, it was not surprising that it was not in many pay packets by 30 April. The Government, not the trusts, gave that authority.
The Minister for Public Health might tell her colleague that, in addition to speedy action by trusts, the Government must press the buttons when pay awards are announced. Nurses have told me how disheartening it is to be told that they are valued and loved, but that no one is sufficiently bothered to make sure that they get the pay increases that they may desperately need.

Ms Linda Perham: I have listened as the hon. Gentleman has outlined the problems associated with nurses' pay, dentists and doctors in trusts and health authorities, including my own Redbridge and Waltham Forest health authority. I am sure that he appreciates that the Government have put billions of pounds into the health service, so what solution does he offer to all the funding problems?

Mr. Hughes: That is a perfectly valid question, and I have some proposals to make. I always try to put my own suggestions on the table.
First, however, let me deal with two other troubled sectors. Junior hospital doctors are at risk. I attended a national forum in Bath the other day to talk to junior doctors who feel undervalued and under pressure. It is hard enough to get into medical school. If people come out feeling that the health service does not want them, they will go abroad or into employment in the private sector and our huge investment in the cream of the cream will be lost.
We need more training places, and the Secretary of State is alert to that, but we must also ensure that junior doctors do not believe that they will be abused by having to work too many hours. I do not want to repeat the debate about why the Government proposed a 65-hour limit when they say that they want a 56-hour limit, although it seems to me that something has gone badly wrong. We must correct the message by saying that that proposal has been withdrawn. Until they hear that that is so, junior doctors are right to believe that there is a risk that they will be asked legally to work more than 56 hours and up to 65.
The third area in which something must be done is general practice. Turnberg said clearly that the number of GPs in London needed to be increased to match numbers in the rest of the country. As the hon. Member for Ilford, North (Ms Perham) may know, we have far fewer doctors per head of population than all other European Union countries, bar one. If we are to have a proper health service, we must have enough doctors.
I have suggested before how we might achieve the right number of health service staff, but I shall repeat my ideas. We could offer bursaries to people to work in the health service, as used to be done for people entering the services or signing on to work for ICI. We could offer a deal, helping people through training in return for several years of service. We could offer loyalty payments to those who stay in the health service rather than deserting for richer pastures.
The regrading proposals being considered by the Government would allow people to be graded at higher levels and paid more while still undertaking hands-on professional activity. We could offer incentives for returnees, not simply saying that they will not have to pay for training, but giving some additional half-year payment if they return for three to five years.
Finally, the Secretary of State was right to say that strategic provision of accommodation for health service workers in London would replace the lottery of being unable to find anywhere because a nurses' home has been abolished. I suggest that the Housing Corporation could be asked to provide, through a housing association, something that might provide corporate housing for the NHS across London. To be honest, some of the hospitals are so near each other that they do not each need their own staff accommodation; but sufficient provision in the right places is needed.
Finally, from the viewpoint of patients, I come to the issue of waiting lists. As the Secretary of State said, waiting lists have come down. However, waiting times have not. The number of people who wait more than 12 months is still in its thousands. Although there are now none waiting over 18 months—nor should there be, because it was a patients charter obligation that there should not be—when will we have a guarantee that no one will wait more than 12 months either between seeing his doctor and seeing his consultant or between seeing his consultant and being treated?
The regional figures for London are still bad news. I have the North and South Thames figures rather than the new London regional figures. Since Labour came to power, there has been a 77 per cent. increase in North Thames and a 112 per cent. increase in South Thames—up from 43,000 to 76,000 in North Thames and from 26,000 to 55,000 in South Thames—in those not seen by their consultant for 12 months or more after having been seen by their GP. In other words, the number of those waiting for a consultation has effectively doubled since Labour came to power. That is no good. It is no use telling a patient that the time between seeing the consultant and getting the operation has been reduced if the time the patient has to wait to see the consultant has doubled. Both waiting times must be considered together. Resources are required to tackle both at the same time.


Cancelled operation numbers remain high—when people are told on the day or the day before that they cannot be admitted—and need to be tackled.

Mr. John Wilkinson: Will the hon. Gentleman give way?

Mr. Hughes: I will not give way only because I am aware that the hon. Gentleman and others may wish to speak and because I have taken a couple of interventions.
The Secretary of State, rightly, introduced a review of beds and we applauded him for it. He tells me that work is being done and that he will return with proposals. Turnberg was clear in saying that we had no excess number of beds in London. We were pleased to hear that because the previous report suggested that there was. Yet, since the Government have come to power, we have lost 651 beds in acute, geriatric, learning disability and maternity provision. We have lost 16 maternity beds, six learning disability beds, 85 geriatric beds and 569 acute beds. As far as I am aware, only mental health beds have increased, by 116. If Turnberg said that we did not have enough beds, for a Labour Government two years later to deliver 651 fewer beds is not to solve the problem. I am prepared to wait a few months for the Secretary of State to come up with a considered view, but he will not honour any implied or expressed Labour party commitment to save the NHS if the Government do not provide the beds we need—not for those who are being dealt with as day-case patients, but for those who need them.

Mr. Clive Efford: I should like some clarification of the figures. An extensive building programme is taking place which will result in an increase in the number of acute beds on those that currently exist. Are they included in the hon. Gentleman's figures?

Mr. Hughes: I quoted from parliamentary answers to me about the number of beds when the Government came to office and at the last date when that number was recorded. Obviously, the figures do not include beds that do not exist yet. I accept that there is a building programme and that more beds will be provided, but that is no consolation to a patient who needs a bed now. Therefore, my question is: how are we dealing with the current shortage and when will we make up the shortage, let alone have the additional beds that we need?
On the provision of in-patient services, not only do we need more beds generally, but we specifically need staffed beds for mental health—another Turnberg recommendation —and to ensure that we get the reorganisation of services right. Some of such improvements will be brought about by the new planned Greenwich hospital in the hon. Gentleman's part of the world.
One of Turnberg's proposals is that no A and E department should treat more than 100,000 admissions, based on a report by Professor Browse. Turnberg went on to say:
Closures should therefore only be planned where access to patients is not compromised, the number of patients attending remaining A and E departments is not so large that it overwhelms the staff and accommodation, and the number of beds available is sufficient to cope with the increased admissions.
There may be different views about who did what to the health service in terms of A and E provision, but—the Minister, more than anybody, will be aware of this—

the Government's decision to confirm the proposals of the last Government, which they need not have implemented, to close the A and E department at Guy's was probably the most unpopular decision that the Labour party has ever made for my constituents. Certainly, it has meant that the Labour party is viewed with much less credibility in my part of the world. Given that the decision has now been made, which clearly my constituents, including Labour councillor colleagues, and I opposed, what is the procedure for making sure that the alternative facilities at St. Thomas's can cope? I have seen nothing to suggest that there will not be more than the upper limit recommended of 100,000 admissions a year having to be treated at St. Thomas's, however good the staff are. We cannot take a gamble on other hospitals being able to pick up the pieces when, for example, we close the A and E department at Guy's.
I shall conclude with a list of proposals. First, for those who are mentally ill and who have a history of violence to themselves or others, please may we have a named professional responsible for co-ordinating their care? In so many cases, the health service, social services, housing department or local authority have all been doing their own thing. Somebody must take responsibility for those people.

Mr. Nicholas Winterton: Is that compulsory?

Mr. Hughes: It is not, but, where a person has such a history and convictions, somebody needs to be held to account to ensure that that person lives in a place where he does not disrupt the neighbourhood, where he has the drugs and takes them if necessary, where if he needs to be readmitted, he will be readmitted, and where if an order needs to be served on him, it will be served. Far too many, although not huge numbers, of such people are wandering around and, regularly, some people are killed and others are threatened and injured by them. I hope that the Government can agree to that straightforward proposal.
Secondly, may we have a system in place so that, if people are troubled by the advice or service given by a GP, they have a right to a second opinion from somebody who might be designated a GP consultant in their area? Many of my constituents have been unhappy with their GP. It is difficult to change one's GP and it often takes a long time to do so. A patient may not want to change his GP, but may just want a second opinion.
Thirdly, may we have a similar system for in-patients? Over the years, a stream of constituents have said that they felt uncomfortable and did not feel that their relative was being treated properly. In every hospital, at every hour of the day, there should be somebody on duty, possibly not employed by the health service, to whom in-patients, friends or relatives can go with their complaint or concern. That person should not be directly involved in the care of the patient. A complaint system that does nothing for six months makes people angry, impatient and frustrated. It may also come too late. A system that deals with complaints there and then would be far more responsive.
Fourthly, may we have a regular review of transport services to and from hospitals? In Sutton and surrounding areas, the local authority linked up with the health authority and the trust to make sure that the buses ran from where people lived and shopped to the hospital at


the appropriate times. It is no good buses stopping at 6 pm. They need to run during visiting hours in the evening and at the weekends, so that people have access to the hospitals. Fifthly, can we concentrate on improving the waiting areas of many of our hospitals? They are grimness exemplified. A lick of paint and a little money would improve them.
In conclusion, there are lots of big issues coming down the tracks. There are questions about whether London will be prepared for the millennium, and about ensuring that we have primary care groups coterminous and working with local authorities. Our views, however, are these: as soon as possible, there should be a democratic regional tier for the health service in London and we hope that London regional government will be given that responsibility; as soon as possible, there should be a merger between health and social services to reduce management, improve co-ordination and the delivery of services; and all the parts of the health service should be brought together, so that the range of services—from self-medication to NHS Direct, the local chemist, the clinic, the surgery and the hospital—are seen to be part of a family of services to be drawn on, depending on the acuteness of one's need.
However, there must a real growth in the resources allocated to our health service—a growth in the share of the gross domestic product devoted to it—so that we can reach the same levels of care as comparable countries. Without that growth, we shall always struggle. There must be a real growth in the number of staff, who can be paid for from the growth in investment, and a real growth in accountability. We probably have the best health service in the world, but it could be very much better. The people of our capital city want that, and they are asking for it urgently.

Mrs. Eileen Gordon: It would be impossible to discuss the modernisation of the national health service in London without first talking about why we need to modernise. I shall talk about acute services, because that is where I gained the little knowledge that I have on this subject. I shall talk particularly about Oldchurch hospital in Romford.
I have campaigned to save Oldchurch hospital services for at least the past 10 years, on and off. Before that, I tried, with others, to save Rush Green hospital in Romford, but the previous Government sanctioned its closure and the land was sold off. That land would have been the ideal site for a new hospital for the people of Barking, Dagenham and Havering. We suggested that at the time, but no one listened, and that opportunity has now gone.
When I tell the House that we campaigned to keep the accident and emergency department at Oldchurch, I must expound on that a little because it was a splendid campaign. We did not have the resources—the people or the financial resources—of the Bart's campaign, but we cared as passionately about our hospital and we certainly made a great deal of fuss. Every Saturday for about two years, we had a stall in Romford market. We took thousands of postcards to the regional health authority. We held candlelight vigils, and circled the hospital with

about 700 people linking hands. We visited one regional health authority with our arms in slings—which was a bit embarrassing when the tea lady insisted on helping us with our cups of tea.
Our campaign, supported by the local press, touched every family in our community. We even had a mascot, which bore a striking resemblance to the right hon. Member for South—West Surrey (Mrs. Bottomley), the then Secretary of State for Health. It was made on the guy principle, although of course it was a gal. She went everywhere with us—on the stall, up to London in a wheelchair, on candlelight vigils. The trouble was that she was stuffed with paper and her legs just grew and grew. In the end, to get her into a car, we had to wrap her legs around her neck. She was in a sorry state-like the national health service under the previous Conservative Government.
Certainly Oldchurch hospital, with an uncertain future hanging over it, was also in a sorry state; no money was spent on it and little maintenance was carried out.

Ms Perham: I should like to pay tribute to the campaign for Oldchurch hospital with which my hon. Friend was involved over many years in the constituency that she serves with such distinction. Does she agree that it is important for us to achieve effective co-ordination and planning of hospital services throughout London, so that the viability of existing hospitals, such as King George hospital in my constituency—which most of my constituents use —is not at risk?

Mrs. Gordon: I entirely agree with my hon. Friend; I shall deal with that point later in my speech.
At the time of the campaign, I was a member of the community health council when we were invited to see the cockroaches in the nurses' home—not a very edifying sight. By 1997, the staff of the hospital were demoralised and everything was in limbo. However, the campaigners did not give up because we knew that we were right.
During the general election campaign, I never promised that we could save the Oldchurch services, but I did say that the only chance was a change of Government, and so it has proved. Early on, the Labour Government set in train the review of London's health services. The Turnberg report confirmed what members of our campaign group had always known—that the general hospital should be at the heart of the community at Oldchurch and that, furthermore, we should have a new hospital.
We now await the decision to go ahead with the project and, yes, I am impatient about it, but I have already waited 10 years and am prepared to wait a bit longer, because I know that we have a good scheme. However, I have to say that I am waiting for the decision with everything crossed and that gets a bit uncomfortable, so I do hope that it will be announced shortly.
In the meantime, the buildings are old and old-fashioned. The staff are working their socks off to provide a first-class service in third-class buildings. I was therefore extremely pleased when the Government awarded £748,000 to improve the accident and emergency service until the new hospital is built. I have always believed that a minor injuries unit should be part of any accident and emergency department, and I am glad that that is one of the uses being made of the money. It always


made sense to me; I thought that keeping people with minor injuries at the back of the accident and emergency queue was daft, and that it would be best to treat them quickly, so that they could go home rather than hang around for hours waiting for minor treatment.
The hospital will also improve the children's accident and emergency services, providing an additional treatment area. It is important that young children should not have to suffer the distressing sights in adult A and E departments. There will also be an out-of-hours primary care service, where patients can get advice or treatment from a GP. There will also be an observation area with six beds, which, we hope, will speed up ambulance turnaround and free up trolleys in the A and E department. When in place, those Government-funded strategies will transfer to the new hospital, because they are mainly about new ways of working and not so much about bricks and mortar. They will greatly improve the services given to the 90,000 patients who attend Oldchurch A and E department each year.
The staff have been involved in developing those ideas, just as they have been involved in working up the plan for the new hospital. Their input will be invaluable in ensuring that the new hospital will really meet the needs of its population in the new millennium. In the meantime, the Government money will help to ensure that patients get the best possible care.
I have highlighted one hospital and one modernisation scheme, but the most exciting aspect of the changes that are taking place is that, from Turnberg onwards, we are considering London as a whole and planning service provision across the whole capital. A few years ago, we saw the horrible spectacle of hospitals poaching patients and competing for contracts. Hospitals were seen as a commercial threat to one another. It was appalling. The new ethos of partnership and co-operation instead of competition will bring great benefits for Londoners using our hospitals and for all those marvellous people who work in them.

Mr. John Randall: I am pleased to follow the hon. Member for Romford (Mrs. Gordon) and to hear about the campaign that she has undertaken over the years. Later in my contribution, I shall touch briefly on some issues that affect local hospitals in my health authority. I am grateful for the opportunity to speak in this important debate as it enables me to air my concerns and those of some of my constituents regarding the national health service in London.
I begin by paying tribute to all those who work in London's health service—the doctors, nurses, midwives, health workers, support staff, managers and members of the ambulance service. They succeed in delivering a remarkable service, despite the many constraints and problems that they face.
That the national health service has a unique place in the public's affections is in large measure thanks to those who work in it. The NHS in London provides a service to the 7 million people who live in the London area, to the 1 million who work here and to those who come specifically to London for treatment. London is also a major centre of academic excellence and research, which contributes to health care both nationally and internationally.
The NHS celebrated its 50th birthday last year and, like most 50-year-olds, it has witnessed many changes since its birth in 1948. It now faces new challenges and new problems. Changes in demographics and technology have fuelled ever-rising expectations; for example, people now live an average of two years longer than they did in 1979. Increased longevity, combined with changes in public expectations of what the health service can and should do for them, ensures that the demand for health care continues to outstrip supply. Since its inception, the service has faced that basic, inescapable fact.
We must question the idea that once, long ago and lost in the mists of time, there was a golden era of the NHS, when everything ran perfectly and there were no problems. My first memory of Hillingdon hospital, Uxbridge dates back more than 30 years, when, as a schoolboy, I arrived at the accident and emergency unit with a broken wrist one Saturday lunchtime. More than eight hours later, I finally saw the consultant and the wrist was set. Such delays were by no means unknown in those days, but expectations were not so high then.
Today, the existence of those expectations and the ever-accelerating and extremely welcome advances in medical knowledge and treatments drive the need for modernisation of the NHS, because the NHS must do more, for more people, as cost-effectively as possible. That might lie behind the Government's welcome damascene conversion to the virtues of the private finance initiative. Any private-public partnership that can ease the pressures on the NHS is to be welcomed. Twenty-five of the 31 new hospitals that the Government plan to build are to be financed through the PFI—an ambitious programme that could go ahead only with private sector involvement.
Any new money is also to be welcomed, even though the Government's tendency to announce and reannounce the same sums at different times and places, while good for spin doctoring, has the effect of misleading the public and greatly irritating NHS professionals. The hyperbole that characterised Labour policy on health when the party was in opposition—the public were told during the election campaign that they had 14 days to save the NHS—has now been seen through. Last winter's cash crisis, to which an increasingly disconcerted Secretary of State admitted, combined with the waiting lists fiasco, which was a problem entirely of the Government's own making, started to test the public's patience.
It is true that the London trusts have achieved greater reductions in waiting lists than trusts in other parts of the country, and I am pleased to say that the Hillingdon hospital NHS trust has a good record on waiting lists. However, the drive to reduce waiting lists is a fundamental distortion of clinical priorities. None the less, that remains a totem pole for the Government: having spent a long time constructing it while in opposition, they are slavishly determined to continue to dance around it. Conservative Members argue that waiting times are more important than lists: how long one has to wait matters more than how many people are waiting ahead of one.
I was interested in a table that recently appeared in The Observer, in which the Hillingdon trust came top. Apparently, the trust issues the fewest anti-depressant drugs, although I have yet to ascertain from the chief executive the reason behind that statistic. As a great believer in looking on the bright side, I think that it is because we in Hillingdon and Uxbridge are inherently


happy with our lot—as we should be, living in a pleasant suburb located somewhere near our great capital city, yet having access to some therapeutic countryside and green areas, which we guard ferociously. However, I recognise that many are not as fortunate as we are, and that there are parts of the borough whose residents might not recognise my description of the area. Those people must be a priority for the NHS in London.
I should like to draw attention to the problems that Hillingdon hospital encounters in the recruitment and, more important, the retention of nurses. However, I should be churlish not to welcome the introduction of NHS Direct, as west London has been in the vanguard of that innovative service. I wish it well; I hope that its progress will be carefully monitored and that improvements, if and when needed, will be implemented swiftly. I shall not refer in any detail to the Government's plans for the NHS set out in the Health Bill. We debated it earlier this month, and the Conservatives' opposition to it has been made clear. We think that the Bill will make the NHS more inflexible and more bureaucratic rather than help to modernise it.
Instead of repeating my objections to the Bill, I shall turn my attention to some specific problems associated with Hillingdon and the surrounding area. Some of the hospitals that I shall mention are located not in my constituency, but in that of my hon. Friend the Member for Ruislip—Northwood (Mr. Wilkinson), whose work in respect of these problems has been assiduous. I am sure that, if he has an opportunity to speak in the debate, he will flesh out the argument. Many people in my constituency feel strongly about these matters.
Without wanting to bore the House too much with my personal experience of Mount Vernon hospital in Northwood, or threatening to show any scars to back up my tales, I have to say that my association with that hospital goes back a long way. My experience usually accrued in the now-defunct accident and emergency department, where injuries sustained on the sports field were treated.
It might appear to be inconceivable and to require an act of faith to believe that I was at any time regarded as being athletic, but I assure the House that I have photographic proof. I have occasionally wondered when the decline in my athletic prowess occurred and, as I sat watching the Secretary of State today, I came to a sudden realisation. At a formative time in my life, when I was a young and impressionable student from Uxbridge, I resided in the right hon. Gentleman's constituency. Watching him stroke his beard today, I realised that, subconsciously and rather worryingly, I must have adopted him as a somewhat dubious role model.
The problems involving Mount Vernon hospital and the neighbouring Harefield hospital, Uxbridge are serious. There is a proposal to move the burns and plastics unit to either Northwick Park hospital, Harrow, or Hemel Hempstead general hospital. That has raised serious questions about the viability of the regional cancer centre at Mount Vernon, which works closely with the bums unit in its regular work and on general research. The cancer centre, the well-thought-of Gray laboratory and the plastics and burns unit have an excellent track record on breaking barriers in research and patient care.
The Secretary of State knows of local concerns about the implications for the future of the hospital without the burns and plastics unit. Thirty-seven local organisations, two community health councils and more than 80,000 local people have signalled their desire to keep the unit open and ensure the hospital's future. I pay tribute—I am sure that my hon. Friend the Member for Ruislip—Northwood will speak about the subject in more detail if he catches your eye, Mr. Deputy Speaker—to those groups, particularly Community Voice and its chairman, Mike Turner, and to the hard work of my constituent Mrs. Constance Evans, who, despite being in a great deal of pain, has been tireless in her efforts to bring these matters to the attention of all those concerned. Those people and many others cannot be ignored; it is, after all, their national health service.
An expert advisory group has been considering various options for the future. However, real concerns have been expressed about the group's objectivity and its seeming unwillingness to consider all the possibilities. I hope that the interrelationship between the plastic and burns unit and the cancer centre will be a paramount consideration. It is difficult to see how the unit's closure will mean anything other than a deterioration of local provision and a threat to a much-valued facility. Relatively modest additional capital funding would be required to modernise Mount Vernon's facilities.
In addition to the threat to Mount Vernon hospital, the fate of the internationally renowned Harefield hospital hangs in the balance. It is the largest transplant centre in the world. Thousands of operations are performed there, and doctors from 60 countries complete their training at the hospital and then take their skills back to their countries. Under the leadership of Professor Sir Magdi Yacoub, Harefield has become a world centre for lung and heart transplants.
The Government have said they recognise both the unique nature of Harefield and the fact that the interaction of science, research, teaching and services is its enormous strength. The Government also acknowledge that, if the Harefield team were split up, it would be very difficult to reassemble. I was heartened to hear the Secretary of State's earlier remarks about Harefield. I have drawn the attention of the House to the fate of both of those hospitals because of deep public concern. There is widespread local anger about the threats to their survival.
As I have said, my hon. Friend the Member for Ruislip-Northwood and neighbouring constituency Members from both sides of the House have campaigned assiduously for the retention and modernisation of both hospitals. I raise my voice—as I have done in the past—in support of that objective. I am deeply concerned that not only are the wishes of local people being ignored, but the whole process is being conducted in a far from transparent manner. Many fundamental issues should be considered, and I hope that the Secretary of State will ensure that the interests of the people of west London are prioritised above the demands and desires of bureaucracy and short-termism.

Mr. John Cryer: I was pleased to hear my right hon. Friend the Secretary of State refer to the new Oldchurch hospital with an air of imminence, which gave me the impression that it cannot be too far away.


I pay tribute to my hon. Friend the Member for Romford (Mrs. Gordon), who has campaigned for more than a decade to keep the hospital open. Without a shadow of a doubt, if the Tories had won the last election, Oldchurch hospital would have been closed and the accident and emergency department would have been shifted to Harold Wood hospital. That would have disadvantaged my constituents and those of my hon. Friend enormously.
I have quite a long constituency, which extends down to the River Thames. People from Rainham, which is next to the Thames, would have had enormous difficulty travelling to Harold Wood hospital by public transport. Oldchurch hospital is situated in the centre of the conurbation and it is much easier to reach, particularly for older people who travel by public transport. Its proposed closure was little more than an asset realisation: the previous Government planned to sell the land for the maximum price and to concentrate hospital services on those parts of the trust property that were worth considerably less.
We can thank the Labour Government for keeping the hospital open. However, I have some doubts, not about Oldchurch, but about some of the new hospital schemes. I have read in the past few months about the bed levels proposed under those schemes. I realise that the greatest bed reduction since the founding of the national health service in 1948 occurred during the 1980s, when there was a 33 per cent. reduction in the number of beds across all specialties in the national health service. The biggest single reduction was in the number of mental health beds, which were cut by 50 or 55 per cent. That is why, in the past few years, deeply vulnerable and sometimes dangerous people have been left to wander the streets without proper care and medication. The most notorious case was that of Christopher Clunis.
Some of the new schemes propose a reduction in the number of beds to eight or nine per thousand people. The traditional national health service standard is 13, 14 or 15 beds per thousand people. I am more than willing to recognise that technical advances have changed the situation considerably. However, what will happen if there is a winter crisis when many elderly people fall and break hips, legs and arms? If the number of beds is reduced-notwithstanding the huge technical advances-what will happen in those circumstances? I hope that the Minister for Public Health will answer that question when she replies to the debate.
I would like to touch on one or two local problems, the principle one being the shortage of speech therapists. I suspect that that is a national problem, but it seems to be particularly acute in Havering. The health trust covering Barking, Havering and Brentwood, which is responsible for primary care services and therefore for speech therapists, is starting to address the problem.

Dr. Jenny Tonge: Does the hon. Gentleman agree that shortages are a problem common to all paramedical services in the NHS? There is a shortage of all the people who help doctors and nurses in their work. That is due primarily to the very low rates of pay, which the Government have failed to address this year.

Mr. Cryer: I agree that there is a shortage of people working in the NHS in all sorts of specialties. However, the shortage of speech therapists—which, as the hon.

Lady pointed out, is a national problem—seems to be particularly acute in Havering. I am not sure why that is so. The local trust is beginning to address the shortage but, apart from pay, the root of the problem nationally is that we are not training enough speech therapists. We are probably not training enough physiotherapists and other specialists in those sorts of fields either.
Most of those who go to speech therapists in my area—and probably across Havering, Barking and Dagenham—are children who suffer from learning difficulties, attention deficit hyperactivity disorder, autism and other conditions. They are extremely vulnerable. After they have had speech therapy for a few weeks, their therapist disappears and they have to wait for another block of therapy. Those patients are placed in an increasingly vulnerable position. Parents of such children have told me that their children are enormously disturbed and distressed when the therapist whom they are used to is replaced after a few months. I hope that my right hon. Friend will turn her attention to that issue at the end of the debate.
I receive many complaints from older people about an apparent inconsistency in NHS treatment. I draw my right hon. Friend's attention to a survey conducted by Age Concern which was released on 9 April. According to the survey, one in 20 people aged over 65 has been refused treatment by the national health service. A further Age Concern report, by Professor Peter Millard, which was recently released, claims that hospitals could make 72,000 more admissions a year if health and social services worked together to provide comprehensive rehabilitation packages. I know that partnership is an important part of the present programme, but it does not seem to be as effective as I had hoped.
That point brings me to issues that are not directly associated with the national health service, but affect the way in which it works. I refer to living and working conditions. If we started to tackle those in a big way, we would begin to modernise the health service on an enormous scale. We can build all the hospitals and clinics that we like and set up primary care groups, but if we do not tackle conditions that allow, for instance, employers to take advantage of employees and disregard health and safety at work legislation, which in many cases is too loose, we will not achieve very much.
This year, for example, about 4,000 people are expected to die of diseases related to working with asbestos. That figure will go up, not down. An easy way to start to tackle the problem, at least for future generations, would be immediately to ban the importation of asbestos, tighten up on health and safety at work legislation and allow the criminal prosecution of employers whom the court views as criminally negligent; that is difficult to do at present. If we started to make such differences, we would make an enormous impact on people's lives, and relieve some of the burdens and pressures on the national health service.
Those who originally argued for the creation of a national health service and eventually achieved it—I refer to people such as Jimmy Maxton and Nye Bevan—certainly did not foresee a health service run by an enormous army of managers and bureaucrats appointed by the Tory Government. They foresaw a democratically run organisation controlled not only by those who used it, but by those who worked in it, and in the longer term, we should move towards that position.

Mr. John Wilkinson: I am glad that the hon. Member for Hornchurch (Mr. Cryer) referred to the need for a democratically run health service. A theme that I have come across throughout my political experience as a Member of Parliament in London is the gap between my constituents' aspirations and what the NHS is able to provide. The NHS bureaucracy is unwilling to accede to local people's wishes. The hon. Member for Romford (Mrs. Gordon) emphasised this when she spoke from her committed experience of 10 years of fighting for her local hospital, and made it absolutely plain how difficult it was to get the message across.
My hon. Friend the Member for Uxbridge (Mr. Randall), in a speech of great eloquence and force, again brought home our problems in the Hillingdon borough in ensuring that a strongly articulated and well-organised campaign is translated into effective action on behalf of local people by the NHS bureaucracy. To a large extent, it remains to be seen whether we have succeeded.
I shall touch on one or two themes to which the Secretary of State referred. First, London should be the centre for medical research. At Mount Vernon hospital and Harefield hospital in my constituency, pioneering research goes hand in hand with the most advanced clinical treatments—in cancer, burns and plastics at Mount Vernon, and in cardiothoracic treatments at Harefield. The Secretary of State said that it is important to combine research facilities and clinical services. I hope that his policies will bring this about at Mount Vernon and Harefield. He said also that local people want to have access to the highest-quality care. In west London, they have it at Mount Vernon and Harefield. The question is whether they will continue to enjoy it.
I am delighted that the Secretary of State announced again the £2 million of new resources for the second stage of the heart science centre at Harefield hospital. The centre is a monument to Sir Magdi Yacoub's pioneering work in heart and lung transplantation and cardiac treatments generally, and its work is recognised the world over, as is that of Harefield hospital, as my hon. Friend the Member for Uxbridge explained. The hospital is as excellent as it is because of the quality of Sir Magdi and his team.
My hon. Friend the Member for Rutland and Melton (Mr. Duncan) said that there was no asset more important to the national health service than the people who work in it, but he said also that the health service is more effective if there is a genuine partnership between the public and private sectors. We have this in the research work done at Harefield and Mount Vernon; Mount Vernon has important private medical facilities in the Bishopswood hospital, as well as the privately funded research which is conducted at the site.
I shall concentrate on the health service as it is perceived locally because that is how it is judged throughout the capital. It is only by the quality of service delivered to our individual constituents that we can make an informed judgment. In an intervention on the hon. Member for Romford, the hon. Member for Ilford, North (Ms Perham) said that, in the process of modernisation, we should not forget the potential for improving good hospitals. In essence, we should not put all our eggs in new baskets.
There is a drive in the NHS to create more and more brand new hospitals, funded by the public or by the private finance initiative. They have their role, and we welcome them where they are created, but they should not be built at the expense of centres of excellence that have been built up, in some instances, over generations, which still do pioneering work and could do even more such work for a relatively modest input of additional funding. I hope that the cautionary tale I shall tell today will have genuine relevance, particularly for building on success.
Mount Vernon hospital is the biggest cancer centre on a single site in the south of England. The Secretary of State has referred again and again to the importance of cancer treatment; it is at the heart of his strategy for the NHS. One wonders how he or anybody in the NHS bureaucracy could contemplate undermining a cancer centre of such strategic importance and excellence.
Undoubtedly, cancer treatment is enhanced if there are plastic surgery facilities on site, as there are at Mount Vernon. This is not a run-of-the-mill facility, but, with its burns unit and the research done at the site, a comprehensive one. It brings in a great deal of private capital and exciting research, particularly through the Restoration of Appearance and Function Trust charity.
This charity is recognised and appreciated in the House. Many questions have been asked in the other place about its future, and the all-party fire safety group appreciates its work. I must remind the House of RAFT's origins. They lie in the generosity of the consultant plastic surgeons at Mount Vernon who, from their own salaries, put money aside to fund research into plastic surgery and burns treatment. From that small acorn a mighty oak of research has grown, which is internationally recognised and greatly appreciated in the House.
So important is the burns facility that, when its future was called into question, I challenged the chairman of the then North Thames executive, Mr. Ian Mills, to a bet. Mount Vernon is ideally located for burns and plastics work by virtue of not only its complementarity with the cancer unit, but its location. It is in the same borough as Heathrow airport, quite near RAF Northolt and at a modal point of the M4-MI-M40-M25 network. Helicopters may also land there, which is important.
I hypothesised to the chairman of North Thames on the dire eventuality of a major air accident at Heathrow involving many bums casualties. I said, "We will go to Heathrow, you and I, in my car, pretend that an air crash has occurred, and time the journey to Mount Vernon as against that to Chelsea and Westminster hospital," to which Hillingdon health authority was at that time suggesting the burns and plastics unit should be transferred. I said that, if we could get to Chelsea and Westminster in a lesser time, I would give Mr. Mills a crate of champagne. Understandably, he did not take the bet because he knew full well that he had not a hope in hell of winning.
The health authority's incomprehensible proposal aroused huge hostility in the community. There was a series of so-called consultation meetings, which were a charade; the general public asked questions, but the bureaucrats refused to answer them. It was only by dint of massive effort that, in October, we persuaded the regional health authority at least to look again at the future of the burns and plastics unit. An expert committee was established under Professor Lessof. The committee is still


sitting and I believe that it is due to come to its conclusions today. We know that its favoured conclusions—my hon. Friend the Member for Uxbridge described them—are a move either to Hemel Hempstead or to Northwick Park.
I think that I have explained the importance of keeping the burns and plastics facility next to the cancer unit at Mount Vernon, but I should like to mention also the consequences for RAFT, which is a privately funded charity. Why should the donors, who have been so generous over the years, bear the cost of their unit being translated to Northwick Park? I know that a number of Mount Vernon's consultants have said that they are not against the move to Northwick Park and are quite sympathetic to the idea—but only as a second best, because they believe that NHS bureaucrats have prejudged the issue and are determined, whatever the arguments in favour of Mount Vernon, to ignore them and to see that the facility moves elsewhere.

Dr. Tonge: I am a little confused by the hon. Gentleman's argument. He seems to be saying that because Mount Vernon is a big cancer hospital—I will not dispute his claim that it is the biggest in the south-east, although the Royal Marsden might also make that claim—

Mr. Wilkinson: On a single site.

Dr. Tonge: That is as may be. He is arguing that the burns unit must be at Mount Vernon because it is a very big cancer hospital. Cancer is hundreds of diseases, but I can think of only a very small number of them that involve plastic surgery as a consequence. I cannot see the connection.

Mr. Wilkinson: Obviously, I defer to the hon. Lady's medical expertise, but, undoubtedly, both the cancer specialists and the plastic surgeons at Mount Vernon all agree that, time and again, reconstructive work following cancer surgery requires plastic surgery. It is just as fundamental as that. Although I do not belittle the hon. Lady's expertise, taking the burns and plastics unit away from Mount Vernon would undoubtedly diminish the scope of treatments available to assist cancer therapy.

Mr. Gareth R. Thomas: I share the hon. Gentleman's view that the intervention of the hon. Member for Richmond Park (Dr. Tonge) was not particularly helpful to those of us who are campaigning for the future of Mount Vernon hospital, but does he accept that the loss of its accident and emergency unit in 1996, against which I argued at the time, has already diminished its status and made it much more difficult for those of us who are fighting to secure its future, as has been put to me by many of my constituents?

Mr. Wilkinson: Of course the hon. Gentleman is right. I remember making a speech in this place 20 years ago in which I argued that the accident and emergency unit at Mount Vernon should be kept open at night. The then junior Health Minister, now the shadow Leader of the House, my right hon. Friend the Member for North-West Hampshire (Sir G. Young), agreed that it could and should be. A few years ago, however, health professionals argued that it was not appropriate to maintain such a facility, that there should be fewer, better-equipped A and E units in

the country and that, in the interests of our constituents, we should accede to the proposed transfer. Against our better judgment, we went along with so-called professional opinion and, as the hon. Gentleman makes clear, the transfer diminished the range and scope of services at the hospital to the detriment of its longer-term potential. I accept entirely what he says.
As for the Hemel Hempstead hospital, it is interesting to note what West Hertfordshire health authority has suggested for its reorganisation of facilities. This is germane to the modernisation of health services in London. Mount Vernon is in a joint trust with Watford general, which is of course in Hertfordshire, so the West Hertfordshire hospital reorganisation programme has a direct impact on Mount Vernon, which straddles the Greater London and Hertfordshire border.
The West Hertfordshire review has hypothesised about, ultimately, a new PFI hospital on a green-field site somewhere in the west of the county. It has not specified where, but, if it were to be built, both Watford general and Hemel Hempstead would probably close. Furthermore, it has laid claim to the new hospital1 as the location for Mount Vernon's burns and plastics unit. The plot becomes even more complicated because the South West Hertfordshire community health council has officially refused to accept the health authority's proposals, and adjudication rests with the Secretary of State.
I must also mention the work of the Cleft Lip and Palate Association, which is another charity in a particularly important field of medicine for young children. The surgery involved is similar to plastic surgery. The association has always understood the merits of Mount Vernon's work and supported it. I went to its annual general meeting at the hospital only last week.
There is still doubt about the long-term future of Harefield hospital. The Government have conducted a review of cardiothoracic facilities in west London, and the options before us are that things should stay as they are, which would mean that Harefield, which is part of a joint trust with Royal Brompton, would continue in its present form, as I and all my constituents want; that its facilities should be transferred to the Royal Brompton; or that both hospitals' facilities should be combined in a new hospital in the Paddington basin.
Three or four weeks ago, I went to a meeting of the Harefield transplant club, which consists of patients who have had heart transplants and who meet for mutual support. They met at the hospital, as they always do. They were insistent on the merits of Harefield. The hospital is located in open country, in the green belt. It is an ideal location for a heart hospital and it has helicopter facilities, which assist heart transplantation. The work of the heart science centre has already been referred to in the debate. Those in the transplant club pointed out that, although after a heart transplant one is all wired up to machines, it is easy to walk about at Harefield and to go out into the garden. It would be nonsense to try to do that in the busy streets of London. I wrote to the Secretary of State, asking him to see a delegation of the Hamsters, led by me. I am still awaiting his reply.
My constituency contains two regional specialist centres of outstanding excellence, both of which are wholly unnecessarily at risk. They are at risk from some grand design which has been evolved by bureaucrats at a stratospheric level. There has been no effective dialogue


whereby the wishes of local people might be acceded to. We are presented with a series of potential faits accomplis. Luckily, the ultimate decisions have not been taken. The Secretary of State has an opportunity to demonstrate that his actions match his rhetoric and that he believes that the modernisation of hospital facilities in London can take place rationally—building on success and improving good, existing facilities which have stood the test of time, namely, those at Harefield and Mount Vernon hospitals.

Mr. Keith Darvill: I welcome the fact that the debate is being held just two years after the general election which delivered an undeniable mandate to this Government to concentrate on the priorities of education and health. Today's debate provides an opportunity to review achievements, discuss progress on the recommendations of the Turnberg report and raise the health concerns that we all have. The debate helps us all to develop our understanding of the Londonwide health issues. More importantly, it will help us to improve care for those who need it in London and to make progress in areas that have not been addressed adequately in our great capital city.
London has lagged behind other United Kingdom and European cities in its lack of a strong citywide approach to health. In preparing for the debate, I have had cause to refer to the public health report, to which the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) referred and which I commend to the House. The report is entitled "The Health of Londoners" and is prepared by the Health of Londoners project. It states:
It is time for the health of Londoners to be put fully on the map.
That statement is right and that is what is being delivered by the Government.
The creation of the Greater London Authority—the Bill had its Third Reading last night—with an elected mayor for London and a single London office of the NHS executive provides unparalleled opportunities for the health and well-being of Londoners to be given the long overdue attention they deserve.
It should not surprise anyone that poverty, deprivation and social exclusion are the main features affecting health in the capital, as elsewhere. Although inner London seems to fare worst on many, but not all health indicators, the problems associated with poverty and social exclusion are distributed throughout the capital, even in the most affluent areas.
The hon. Member for Southwark, North and Bermondsey referred to a number of points raised in the report, and I want to add one or two important statistics for the record. A total of 940,000 adults in London—17 per cent.—receive income support and 750,000 receive housing benefit. Forty per cent. of the population live in electoral wards that are among the most deprived 10 per cent. of all wards in the country. There are many more statistics that demonstrate the extent of deprivation in London. Such deprivation leads to health inequality and premature death. The report states that the chances of dying before reaching 65 are almost twice as high in the

most deprived areas of London as in the least deprived. That shows that the gap between rich and poor is increasing.
Those statistics were produced at about the time of the 1997 election and illustrate the circumstances that pertained during the Conservative Government. It is clear that, notwithstanding the protestations and assurances from the two Conservative Prime Ministers between 1979 and 1997 and the Health Ministers during those years, the health service was not safe in their hands. It is one of the main reasons for Conservative failure at the ballot box and why there are more Labour Members than Conservative Members in this Parliament.
In stark contrast, my right hon. and hon. Friends in the Department of Health have set about the task of modernising our health service with zeal. Hon. Members will be aware that there is no shortage of reading material and reports on health in London. The most important reference point and the base for this debate is the strategic review of the health service in London, prepared by Sir Leslie Turnberg.
In his letter to my right hon. Friend the Secretary of State dated 18 November, which is when he presented his report, Sir Leslie Turnberg said:
We found a health service under pressure. Services across the whole spectrum of care, from those in the community and primary care to those in hospitals, were sorely stretched. Although the impact of these pressures was most keenly felt in the care of elderly people and those with mental illness, others were not immune from the failures to meet an acceptable standard of service … Furthermore, there is evidence to suggest that the pressures are increasing. Despite ,all this, healthcare workers are doing the best they can and we found examples of good practice, even in areas of severe pressure.
The report makes a number of recommendations, which the Government have accepted. I want to refer to two. First, there is the position of Oldchurch hospital, which has been referred to today by my hon. Friends the Members for Romford (Mrs. Gordon) and for Hornchurch (Mr. Cryer). The report recommends that there should be a new Oldchurch hospital, covering the whole of the Barking and Havering health area. I was pleased to hear the Secretary of State say today that it was one of the areas awaiting prioritisation.
It is important that the decision is made as soon as possible because there is a need to invest in a modern hospital for a modern health service and because of the circumstances of this case. A healthy partnership has been developing between the local authority, the health trust, the community health council, GPs and the five Members of Parliament representing the area covered by the area health authority. Many other decisions are waiting on the decision about the hospital. Community provision, GPs and primary care areas are all awaiting the decision which is, in many ways, the last part of a detailed jigsaw. There are firm reasons why the decision should be made as soon as possible.
The previous Government began to address primary care issues following the Tomlinson report in 1992. In many ways that was too little, too late. The London initiative zone programme badly underestimated the extent to which the previous Government failed in their first 10 years in office. At the time of the Turnberg report, LIZ investment was estimated to have been £265 million. Ultimately, the programme is estimated to have invested £;402 million.


Page 33 of the Turnberg report states:
Despite considerable investment in primary care services in the last few years, services lag woefully behind those in the remainder of the country—the number of practices below recommended standards remains high, too many premises remain poor, single-handed practices represent a larger proportion than elsewhere, recruitment is difficult and the total number of GPs has fallen slightly in the face of a rise across the rest of England.
That is the state of London's health service, at a time when London's population, for the first time in decades, is increasing.
In 1997, in my area, only 8 per cent. of the 124 GP premises in the Barking and Havering health authority were above required minimum standards. I therefore welcome the information provided in the Department of Health's progress report. On page 9, it describes the 73 major schemes that—a year after publication of the Turnberg report—have been completed. Nevertheless, much more has to be done, particularly in my health authority—which the Department's report states is benefiting from four major schemes. However, those schemes go only some of the way towards achieving the minimum standards described in the Turnberg report.
I enthusiastically support primary care groups, which are another major development. A primary care group has been established on the boundary of my own constituency, enabling me to work with doctors who are enthusiastic about the group's work. I congratulate Dr. Haider and Dr. Anthony, who are the group's co-chairmen and are working with the local community in a true partnership. I have attended one or two of their meetings, at which—I am able to report to Ministers—enthusiasm for the group's work was expressed.
People at the group have been telling me that they want to be left alone to get on with creating stability after all the reforms. Nevertheless, I am sure that primary care groups will deliver the rewards that we expect from them.
I believe that primary care groups will have a big influence in addressing some of the issues raised in the LIZ review. I was particularly interested in the review's comments on people attending accident and emergency units. At the North Middlesex hospital, for example, 67 per cent. of patients
suggested that their reason for attending was because their GP surgery was not open.
The report also states that the London ambulance service was
the primary carer for 85 per cent. of patients carried",
and that, overall, London ambulance service
crews assessed that 13 per cent. of their calls were to patients who should have been dealt with by their own GP.
The statistics demonstrate the extent to which primary care groups, GPs and primary carers generally may help us to make better use of our resources.
The House will gather from my remarks that I am enthusiastic about the Government's reforms. London's health service is being modernised. There is still a long way to go, but—with the new primary care groups, new hospitals and the new investment described today—we shall certainly be improving the health service for the people of London.

Mr. Paul Burstow: I should like to start by picking up on the comment made by the hon. Member for Upminster (Mr. Darvill) that there is still a long way to go in modernising and improving London's health service. I wanted to speak in the debate to highlight a few concerns that have been drawn to my attention in my constituency or that my constituents have raised with me in correspondence.
I should like also to touch on a comment made by the hon. Member for Hornchurch (Mr. Cryer). I should deal with that now, as I believe that he is about to leave the Chamber. He made a very important reference to Professor Millard's report and work on hospital discharge arrangements for elderly people. In that work, Professor Millard—who is a constituent of mine—has highlighted the fact that too many of our senior citizens are being discharged from hospital straight into residential care, whereas proper investment in rehabilitation services would have avoided the need for them to go into such care. We have to ensure that more work is done on the issue, to ensure that independence is promoted and that people may continue to live for longer in their own homes.
Professor Millard's work in targeting that issue complements very well the work of the royal commission on long-term care. I hope that the Government will soon be publishing their conclusions and recommendations on how to address that issue. We are growing impatient to hear how they will address it, and particularly look forward to reading the guidance, which is soon to be issued, on discharge planning. I hope that the Minister will be able to deal with the issue in her reply. I was also grateful to the hon. Member for Hornchurch for mentioning the issue, as it reminded me of that research.
I should like also to deal with the merger, in my area, of the St. Helier NHS trust with the Epsom Health Care NHS trust. Although Epsom is outside the Greater London NHS region, by dint of its merger with the St. Helier trust, it will be covered by the London region. I should like to address a number of issues that have arisen from the merger.
The first issue is the concern expressed—not least by the community health councils covering the new trust—that, at the end of its life, the Epsom trust, which no longer exists, had on its balance sheet a £2.7 million deficit, and that that deficit will be inherited by the new trust. The new trust has conceded that there are substantial cost pressures on its new budget, and that those pressures will impact on its ability to operate. Not the least of the pressures are those arising from the pay award, from the European working time directive and from year 2000 problems.
The deficit issue, and how it is handled, is a particular concern for me and my colleagues in the local community health councils. We are fearful that it will lead to "service reconfiguration"—which, too often, is a terrible euphemism for cuts—so that the new trust's budget may be realigned with the money that the health authority and the Government feel that the trust needs to deliver health care services.

Mr. Casale: It is understandable that the community health council, which is also the CHC for my area, will have some concerns about the merger of the St. Helier and


Epsom trusts, but my understanding is that it has broadly endorsed the merger. Does the hon. Gentleman generally endorse it? Does he—as he has mentioned thepotential £2.7 million deficit—also welcome the £3 million that the Government have made available for the St. Helier accident and emergency service in his constituency?

Mr. Burstow: Perhaps I should first clear up the matter of where St. Helier hospital is located. It is in the constituency of my hon. Friend the Member for Carshalton and Wallington (Mr. Brake)—who is unable to be here today, but shares a continuing interest and concern, as do the hon. Gentleman and I, about the provision of services at the hospital.
The hon. Member for Wimbledon (Mr. Casale) was right in saying that the community health council, with caveats, indicated its support for the merger. I, too, have been a supporter of the merger—not least because of the need to reach critical mass in being accredited by royal colleges, and all of the consequences that flow from that, so that the hospital is viable and able to operate. I also welcome the long-overdue, but much-needed investment in our A and E department, so that it is able to address the issues, especially at winter crisis time, that seem to have become an element of the way in which the health service operates. However, Epsom CHC is also concerned to ensure investment in the A and E department to secure the long-term future of Epsom hospital. Anything that the Minister can say about that would be greatly appreciated.
Both CHCs have real concerns about service reconfiguration—or cuts. I hope that Ministers will give further consideration to that today. I hope at least that the new London region will do all that it can, together with the two health authorities that cover the new trust, to ensure a soft landing in managing to bring the budget into line with the resources that will be made available to the trust over the coming years.
The problems in the local health economy in my area and in the constituency of the hon. Member for Wimbledon are exacerbated by the deficits that the health authority has had to grapple with over recent years. A recovery plan is in place to bring that budget into line with the Government's target for health authority spending. I dislike the language of targets and recovery plans, because it disguises the way in which budgets are being reduced. That will make it more difficult for the new trust to bed down in the way that many of us, including the people who rely on the services, would like.
Two other concerns arise from the merger. The first is that the two hospitals are several miles apart and the public transport between them is very poor. The local CHC in my constituency undertook some research and found that it would take about four hours to travel by public transport from St. Helier hospital to Epsom hospital and the journey would cost up to £7. As the services of the two hospitals are brought together and economies of scale are achieved, there will be concerns that people will have to make the journey to secure the treatment that they need. My hon. Friend the Member for Southwark, North and Bermondsey (Mr. Hughes) rightly referred earlier to the work that my local authority has done with the local health service to promote better bus services. I am keen that my local authority and the local health service should

undertake the necessary work now to establish good public transport links between the hospitals to make the trust a reality in the local transport infrastructure.
The second issue is that the trust straddles two NHS regions and two health authorities. The London region will take the lead in overseeing the new trust, but there are concerns among those who represent the interests of patients that the trust may not do so well out of that arrangement, particularly in the Epsom and Surrey area. Anything that the Minister has to say about how the London region will deal with a trust that is not part of its area would be helpful.
I had an opportunity just two weeks ago to lead a deputation of the two local community health councils to see Baroness Hayman. She was very constructive in our dialogue and I was grateful for the meeting. As a result, several messages have been sent back to the trust and the health authority. We look forward to a good on-going relationship between the CHCs and the new trust.
There are two other issues to which I wish to refer arising from my mailbag and representations that I have received from constituents: chiropody services and multiple sclerosis. I regularly attend meetings of the Sutton seniors forum, which recently received a presentation on the joint investment plan being drawn up by the local social services department and the health authority on issues related to ageing and services for elderly people. A well-resourced chiropody service is a key to promoting independence, particularly among elderly people, and unlocking resources that would otherwise be used in acute services and other parts of the care system. The pressures for cost savings are undermining the service, increasing waiting times and restricting the nature of the service that is provided to my constituents and others. Those false economies result in greater costs in the local health and social care economy in my area and in other parts of London.
The need to improve and extend foot care services was not referred to specifically in the Turnberg report, but community health care services were referred to in detail. Although I strongly welcome the merger of the Merton and Sutton Community NHS trust with a number of others to create a new south-west London trust and some of the economies in management costs that should arise from that, I am concerned that the merger may lead to a loss of focus on local situations, not just at borough level, but at individual level. It is essential that the reorganisation of the management structures of health services does not result in the loss of the local connection and focus on delivering appropriate care and treatment. Investment in foot care services must not be overlooked in my constituency or more widely in London. I hope that the Minister will be able to say something about that.
I was fortunate to have an Adjournment debate on MS in February, so I shall not talk about it for too long today. The treatment of MS should be about more than just prescribing beta interferon. It must be set in the broader context of neurological services. A survey last year by the Association of Quality in Healthcare found that 46 per cent. of health authorities did not have service plans or adequate information on which to base plans for tailoring services for those who suffer from MS—rehabilitation services, continence care and many others.
There are only 400 neurologists in the country—the same number as in the city of Boston—and just 58 specialist nurses. At present, 95 per cent. of patients with


neurological conditions such as Parkinson's disease, Alzheimer's and MS are cared for by their GP, not through neurological services. Such degenerative conditions all too often lead to costs falling on social care, when health care would be more appropriate.
The MS drug therapy that we hear about all too often, with debates in this place about rationing, is not the be-all and end-all. However, since 1995, NHS guidance on relapsing and remitting MS has encouraged prescribing beta interferon in the context of advice from neurologists. In too many cases, even when neurologists advise and recommend its prescription, it is not made available. Constituents have written to me to express concern about long waits.
Two weeks ago, the NHS regions were given new guidance on beta interferon that they were about to issue, but it was not issued. I understand that it would have cast doubt on the prescribing of beta interferon, particularly for secondary progressive forms of the condition. During my February Adjournment debate and during Health questions in April, Ministers declared their intention to refer beta interferon to the National Institute for Clinical Excellence. Why was it necessary to issue new guidance when NICE is being set up to give the Government proper advice?
NICE's work on beta interferon is only part of the picture. We need a national neurological services framework. Will the Minister be able to tell us when such work might be undertaken, so that all the issues can be brought together and dealt with systematically?
I have brought these issues to the attention of the House because they are of concern to my constituents and many others in London and have been highlighted in my correspondence. We value and welcome the progress that the Government are making in some areas, particularly some of the additional resources for A and E, but, as others have said, there is still a long way to go to secure the NHS services that we all want.

Mr. Roger Casale: I welcome the opportunity to comment on the Government's plans for modernising the health service in London. I should like to report to the House and to the Minister the progress that is being made in my constituency and in Merton, Sutton and Wandsworth health authority to rebuild the national health service in south-west London and equip it to meet the health challenges and demands of the 21st century. That is happening in the context of wide-reaching demographic change, but in the knowledge that the Government are committed to giving the British people the health services that they need and deserve.
We inherited from the Tory Government a health service that was underfunded and demoralised, fragmented and inefficient and in which competition for scarce resources between different parts and sectors of the health service threatened to undermine the core values, principles and ethos of what was a truly national service and the envy of the world. In just two years, the new Labour Government have put in place a framework for massive year-on-year funding increases, a strategy for tackling health inequalities and a vision for the future of our health service based on modern forms of organisation and a new culture of partnership and consultation to identify and meet health needs.
In London, the Government moved swiftly to set up a strategic review of the health service under Professor Sir Leslie Turnberg. I welcomed that decision and the report when it was published and debated last year. The shortcomings of the health service that we inherited from the previous Government were perhaps no more starkly in evidence than in London. A comprehensive review of health service provision from its very foundations was a strategic priority for London and for the national health service.
Alongside the commitment to increase funding—£21 billion over the next three years—the Government's commitment to implementing in full the recommendations of the Turnberg report stands as a further milestone along the road to rebuilding our health service. My local health authority area has felt the impact of those commitments immediately and will continue to benefit from a Labour Government delivering on their promises for many years to come.
London has suffered from a funding formula that has not truly reflected its health needs. Following a delegation last year to the former Minister of State, Department of Health, the right hon. Member for Darlington (Mr. Milburn)—now the Chief Secretary to the Treasury—which I led and in which the hon. Member for Sutton and Cheam (Mr. Burstow) and my hon. Friends the Members for Putney (Mr. Colman), for Battersea (Mr. Linton), for Tooting (Mr. Cox) and for Mitcham and Morden (Siobhain McDonagh) participated, I am delighted that there will be a freeze on further changes to the existing formula to review key factors such as the age profile and ethnic composition of London's population. I understand that the freeze will continue until 2001, when the working group will report.
The establishment of a Londonwide regional health executive is also a major step forward. Indeed, without it, it is difficult to see how a strategic approach to dealing with Londoners' health needs would be possible. However, I welcome the new regional health executive for the efficiency savings that will now be made by cutting down administrative costs—savings that will be reinvested in the health service in London to reduce waiting lists further and deliver improved front-line patient care.
Organisational change is also taking place at the sub-regional level in south-west London, and I endorse the merger of the Epsom and St. Helier trusts and the appointment of Jennifer Denning as the new chair. Similarly, I am pleased to endorse the community trust merger to which my hon. Friend the Member for Putney referred and the appointment of Dr. Liz Nelson as chair. The new trust will not be coterminous with the health authority area, but I support it because the inclusion of the Richmond trust will provide the critical mass necessary to make Queen Mary's hospital, Roehampton viable as a community hospital and also because of the strategic advantage of such a merger in the context of providing a quality health service for south London.
Most of all, however, I should like to take the opportunity to thank the Minister for the extra resources that have been made available to my local health authority over and above what was due to us through the national resource allocation on the existing formula. London—and especially south-west London—had been so starved of resources by the previous Government that one of the first


reports that I was given to read by my local health authority after my election in 1997 was entitled "The River Runs Dry".
This year's budget for Merton, Sutton and Wandsworth health authority represents a cash increase of 6.3 per cent. and a real-terms increase of 3.8 per cent. In addition, the Government have provided £3 million to improve and enlarge the accident and emergency department at St. Helier and £2 million to cope with winter pressures. As a result of those and other changes, the burden of financial deficit across the local health economy has been reduced from £25 million in 1997-98 to £3.4 million for 1999-2000. The reduction in waiting lists at St. George's and St. Helier and across Merton, Sutton and Wandsworth health authority area has exceeded the Government's target by 4.3 per cent.
Further much-needed and important organisational changes are also going ahead at the initiative of local health decision makers and with the support and active involvement of the Government. In respect of mental health care, for example, Sutton and Pathfinder mental health services are to merge and Pathfinder has now received approval to redevelop its provision on the Tooting site. One site will now provide in-patient adult services for all Merton residents and a women-only area will be part of the new development. Most important, six primary care groups are now in place across the health authority and chief executives have been appointed to each.
The Nelson primary care group in my constituency, jointly chaired by Dr. Howard Freeman and Dr. Martyn Wake, is already playing a key strategic role in shaping the way in which health services will be delivered in our local community in future. Together with the St. Helier trust, the health authority and other local stakeholders, the Nelson primary care group is developing exciting new plans for a new community hospital on the site of the Nelson hospital in Wimbledon. The project will eventually house the Nelson primary care group and give local commissioning GPs a central role in the delivery of consultant-led services on site, relieving the strain on the large district hospitals and providing locally based services to the community in the heart of the community and, thanks to the community health council and the Wimbledon Civic Forum's health forum, in partnership with the local community.
New developments are also expected with regard to the future of the Atkinson Morley's hospital in my constituency and I thank the Minister for his intervention last year to ensure that the paediatric neurosurgery unit currently based at the Atkinson Morley's hospital will move with the rest of the neurosurgery department to the new PFI-led neurosurgery and cardiac unit at St. George's hospital in 2002.
For all the false sentimentality expressed by the hon. Member for Rutland and Melton (Mr. Duncan) about health service buildings, it is important to remember that Labour is more interested in the level of service. Atkinson Morley's services are not being broken up or reduced; they will be moved in their entirety to more modern buildings at St. George's, and I support that move.
I close my remarks by referring to what may be the most difficult and challenging task facing the Government in their drive to raise standards of health care across

London: the need to bring about a cultural shift in the way in which the health service operates as the NHS moves to centre stage as the key public institution in our joined-up approach to creating a fairer, stronger and more equitable society. "Partnership" and "consultation" are the key words. They are easy to say-we all know what they mean-but more difficult to put into practice. How many of us know how to do that effectively?
Historically, the whole ethos of the NHS rests on co-operation and partnership to take forward a common endeavour in the public interest-caring for the nation's health-but that ethos was systematically eroded by a generation of Tory Governments and it will require not just good faith and good words, but hard work, organisation and perhaps further statutory duties to consult in order to reverse the decline. For example, consultants will have to learn to work more committedly in partnership with doctors if community hospitals and primary care groups are to deliver their full potential contribution to public health. It will not be enough to knock down the Berlin wall between social services and health services; many bridges will need to be built if we are to achieve a seamless service as planned.
Throughout the process, clear performance criteria must be laid down. Those criteria must be public and they must be publicly monitored. Above all, local communities and patient groups must have a stronger voice in the framing of health improvement plans and the shaping of local health strategies generally. Such an approach will help to deliver quality and equality in the health service by rooting out substandard performance and by identifying best practice and spreading it around.
The Wimbledon Civic Forum, which I established in my constituency and which I chair, brings together local residents and community groups to discuss issues of common concern with key decision makers. It is a valuable additional channel for communication and consultation in that regard.
The Wimbledon Civic Forum's health forum, under the chairmanship of Mr. Albert Johnson-together with the local community health council, under Dr. Lea McDonald-is leading the consultation on service provision at the new Nelson community hospital. The health forum has also held meetings with the chief executive of the health authority and the head of social services of Merton council to discuss the authority's health improvement plan, its strategy on mental health care and the authority's relationship with local community and social services. I ask the Minister to encourage such initiatives as a valuable way of helping to promote a cultural change in the way in which all our public services operate, as much of our success in modernising the NHS in London will depend on bringing that cultural change about.
In conclusion, our future in Merton, Sutton and Wandsworth is now vastly better secured as a direct result of the Government's response to Turnberg, the comprehensive spending review and the additional benefits delivered by the Government over and above these two, such as NHS Direct, walk-in centres and many others. I assure Ministers that, in my constituency and in south-west London, we support and are working to implement the changes that they are seeking to bring about across the country as a whole.

Mr. Nicholas Winterton: The hon. Member for Wimbledon (Mr. Casale) made a constructive and well-informed speech. My only criticism is that, in parts, it was too flagrantly party political, as if only one party could serve the NHS. Since the establishment of the NHS, successive Governments from across the political spectrum-whatever some Opposition Members might say, or whatever some members of the public might think-have been united in their commitment to the NHS, a service providing treatment free at point of delivery. There may well be differences on how the funds and resources for the NHS can be found, but the hon. Gentleman will find, after he has been in the House a bit longer, that no one here is opposed to the NHS and its pre-eminent position in the provision of health care.

Mr. Casale: I share the hon. Gentleman's commitment to cross-party consensus, where possible, and I try to practise it in my constituency. However, one of the reasons why I joined the Labour party was that I believed that the NHS would not have a future were it not for a Labour Government. I have not been disappointed in that regard.

Hon. Members: Hear, hear.

Mr. Winterton: The hon. Gentleman has some support from his hon. Friends. I have been here a goodly number of years, and I had the privilege to serve for a time on the Select Committee on Social Services. When that Committee was divided between health and social security, I chaired the Select Committee on Health for two years. There was tremendous co-operation among all members of that Committee, who were totally convinced that our NHS was the best in the world.
The Committee wanted to improve the NHS, and we worked to produce reports that would provide a better service for the people of this country. I chaired that Committee as a Conservative and Unionist Member of Parliament. The hon. Member for Wimbledon may be aware that I was not always as warmly supported by my party colleagues as I might have been. Notwithstanding that, there are many hon. Members on both sides of the House who are committed to the concept and principle of the NHS.

Mr. Andrew Love: Does the hon. Gentleman accept-as the hon. Member for Ruislip-Northwood (Mr. Wilkinson) appeared to-that there was considerable concern in Greater London at the time of the general election about the thrust of the previous Government's policy towards health in the capital?

Mr. Winterton: The hon. Gentleman is right, and the country as a whole had a perception about what the then Government wished to do with the NHS. I think that that perception was wrong, and my hon. Friend the Member for Ruislip-Northwood (Mr. Wilkinson) was right to articulate that today.
At the risk of upsetting my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth), I can say that the Conservative party has sought in what it has said recently-despite being misunderstood by some sections of the media-to establish once and for all that

we are committed to the NHS. We want to improve it and to get more money into London, where there are problems. Those problems have been articulated remarkably well in the debate.
Ten months ago, I had an unfortunate fall in Trafalgar square. I have nothing but praise for and appreciation of the speed and efficiency of the London ambulance service and the paramedics who crewed the ambulance. Likewise, I have every admiration, respect and regard for the service and attention that I got from the hospital just across the river-our hospital, St. Thomas's-when I was taken to the accident and emergency unit. The service was first class. I experienced virtually no delay, and I greatly appreciated the service. That experience was important, as it gave me an opportunity to appreciate what the NHS can do. I praise the NHS.
Members of my close family live in London, and five of my seven grandchildren were born at St. George's hospital in Tooting. Pressure on the maternity and labour facilities at the hospital cause concern, but the quality of service and attention that mums-to-be get at St. George's is high. We have much to be thankful for in terms of the hospital services in London.
As I said earlier, I served for many years on the Social Services Committee; initially under the redoubtable leadership of Mrs. Renee Short, whose commitment to the NHS was never doubted. We worked closely together. One thing that is of immense benefit to the House is the Select Committee system, in which members of all political parties sit on a Committee, undertake an inquiry and, at its end, produce a report that is based on the oral evidence given to them, the experience of visits and the written memorandums that have been submitted. My experience on the Social Services and Health Committees was that we were committed to the health service and to social services, and we wanted to produce reports that were based on the factual evidence given to us. Many of the reports had cross-party support in the House as well as in the Committee. I believe that the health service benefited, and continues to benefit, from the work of the Health Committee.
I had the privilege to have as advisers on health over the years such learned medics and clinicians as Professor Richard Beard of St. Mary's, Professor Osmond Reynolds of University College hospital, and Dr. Luke Zander, a GP who is about to retire and who was immensely helpful and brought great commitment and experience to our deliberations, helping us to produce reports that have aided the delivery of health care.
Concerns have often been raised, especially by those who happen to be in opposition, about the hours worked by junior doctors. I am well aware of the problems that face any Government seeking to reduce those hours, but many of us, including myself, remain somewhat concerned that, although the Government rightly intended to reduce the hours, they will not be reduced as quickly as we had hoped. I hope that the Minister will clarify the matter when she replies to the debate.
My hon. Friends the Members for Uxbridge (Mr. Randall) and for Ruislip-Northwood asked, very constructively, about current facilities and specialties at hospitals in their constituencies. I raise those matters not because they have asked me to do so, but because other people continue to write to me on the subject because of


my known commitment to and interest in our national health service. I hope that the Minister will respond appropriately.
I appreciated the way in which the hon. Member for Upminster (Mr. Darvill) delivered his speech, which was both considered and constructive. It is important for hon. Members to present their knowledge and views to the House in a way that can be accepted across the party divide, even if people disagree. The health service is too important to be a party political football.
I am concerned about the long-term care of the elderly in London. I continue to be approached personally and to receive correspondence on the issue, even though I represent a constituency about 175 miles from London. There is widespread recognition, across the political spectrum, that the current arrangements for funding long-term care of the elderly are both unsatisfactory and unfair.
My party made proposals before the general election to begin to address the current unfairness, but it did so far too late and, sadly, the incoming Labour Government rejected those ideas and chose instead-I can understand the reasons-to set up a royal commission to consider the question of long-term care for the elderly. Having recognised the problem as urgent in opposition, the Government deferred any decision on what I readily accept is a difficult issue by establishing the royal commission.
I know that the royal commission has sought evidence from a wide range of sources, and it has produced a report that, although it may not tell us anything new, comprehensively and accurately lists the issues, options and views that were presented to it. Clearly, the Government will shortly make a positive response. The current arrangements are unfair and the matter needs urgent attention.
The proposals made by my party when in government would have met the immediate needs of today's elderly population, and especially those in London, and would have eliminated much of the unfairness in the system of funding long-term care. It could have formed an important element of a long-term solution to the problem for future generations.
As the Minister knows, the proposal was based on the concept of asset insurance, which would have allowed people to protect the assets that they had accumulated through thrift and hard work. Members on both sides of the House want to recognise thrift and hard work, and to encourage them for the future. That would have been achieved in a partnership insurance scheme with the state. Again, I am sure that that would appeal to both sides of the House. I am not trying to put everything into the private sector, or the private basket, as some people say.
That is the best, simplest and most affordable proposal that has yet been made. It is unfortunate that the Government's comprehensive rejection of the plan when they were in opposition-they ruled out the asset protection partnership scheme in advance-has left them with little room for manoeuvre. As so many people in London will be affected, I hope that the Minister will be able to make some response, even if it is only a holding response, to what I have said on the subject.
Two years into the Government's period in office, many people will feel that we have scarcely moved forward on the issue. Behind the "Whitehall-speak" about further consultation and extensive debate, there lurks the suspicion that the Government-this could be said of a Government of any party-having used the device of a royal commission to delay things for nearly two years, have no intention of accepting its proposals, yet have no alternative of their own to offer. Sadly, they appear to have kicked the question of long-term care into the long grass.
The subject was of tremendous interest to me throughout the 18 years that I was involved with health and social services. The problem remains with us today. Any durable solution to the challenge of funding long-term care for the elderly must address as a matter of urgency the sense of injustice felt by many older people who have worked and saved all their lives, only to be forced to sell their assets to pay for their care.
The system put in place must be sustainable and based on a partnership between the state and the individual. Surely that is what the House wants-to provide for the care needs of generations of older people. So far, there is no sign that the Government have recognised the true urgency of the twin imperatives that I have outlined.
Finally, I apologise to the House for having had to nip in and out of the debate so frequently before I was called to speak. As I explained to you, Mr. Deputy Speaker, there are few Members here today, apart from those who represent parts of London. At one time the House looked like a sitting of the Standing Committee on the Greater London Authority Bill, which I had the honour and privilege of chairing. Except for the fact that you, Mr. Deputy Speaker, or one of your colleagues has been in the Chair, and the fact that there were "strangers" on both the Government and the Opposition Front Benches, those who have spoken today overwhelmingly make up the membership of what I have described as the extremely well-informed and entertaining Greater London Authority Bill Committee.
I apologise to the House for my erratic attendance, but I had duties with the Commonwealth Parliamentary Association, which was holding a lunch here today. Many people from the Commonwealth were here, and there were too few of us to accompany them.
I have found the debate informative and useful, and I hope that Members on both sides of the House have found my contribution both constructive and positive. I strongly support our health service, and I want to see it continue to provide an improved service for the people in London and throughout the country.

Ms Joan Ryan: I am pleased to speak in this debate today, because we have a good story to tell about this Labour Government's care and concern for, and resourcing of, the health service in London in the past two years. As other hon. Members have done, I wish to refer back to the Turnberg report of November 1997, because of its importance to London and the significant difference it made to the people of Enfield, North and the security they feel about the future of Chase Farm hospital.
For some 10 years, Chase Farm hospital had been continually under threat. Its accident and emergency department was threatened with closure, but the local


public valiantly fought against that time and again. However, they were beginning to feel that one more threat would see them off. The Turnberg report told us that London did not have an excess of beds and that an A and E department with between 50,000 and 100,000 new attendances per annum was the desirable size. Those two statements made Chase Farm hospital feel that it had a future.
Although I accept the comments by the hon. Member for Macclesfield (Mr. Winterton) about his individual commitment to the NHS, I do not accept that about the previous Tory Governments. It was always obvious that London was not over-bedded and that basing the number of beds needed in London on the blip in one year's figures in the Tomlinson report was irresponsible. Closing beds, and putting A and E departments under threat on the excuse that the beds were not needed, was a means of cutting resources to the NHS. That demonstrated that the NHS was not a priority for the Conservative Government. Words are easy and cheap, but many people, in London and nationally, found to their cost that the words "safe in our hands" meant nothing.
The hon. Member for Rutland and Melton (Mr. Duncan) talked about deceit and claimed that many Labour party candidates said that hospitals would be closed if people voted Conservative on 1 May 1997. Yes, we said that. I said it, and I meant it. My hon. Friend the Member for Hornchurch (Mr. Cryer) revealed today that he said it, and he meant it. I am certain that Chase Farm hospital would have no A and E department and would have been left to wither on the vine, which is what happens to district general hospitals when they lose those departments, but instead it faces a bright future. It was not deceitful to say that: it was the truth. When we told people that their hospitals would close, we had the evidence of the previous Tory Governments who put many hospitals under threat and closed others. We now have the evidence that this Government have ensured a future for those hospitals.
I pay tribute to my hon. Friend the Member for Hendon (Mr. Dismore) who worked very hard, from the time that he became the candidate for the constituency and since 1 May 1997, to try to protect Edgware district general hospital. My hon. Friend the Member for Harrow, East (Mr. McNulty) is right to say that its A and E department was closed by the previous Conservative Government on 1 April 1997. During that process, they ran the hospital down and undermined and demoralised it so completely that it subsequently closed. My hon. Friend the Member for Hendon has worked hard with our Labour Government and local groups to establish a successful community hospital there with a bright future. I do not think that that would have been there if there had been a fifth successive Conservative Government. Instead, we might well have had a housing development on the site, or something similar. We certainly would not have had a hospital there.

Sir Sydney Chapman: I take a great interest in what goes on at Edgware. The accident and emergency department there was not shut on 1 April, although its closure was planned for that date-by the previous Conservative Government, as I accept-and accomplished a couple of months later. However, does the hon. Lady acknowledge that the closure of that department was balanced by a new, larger accident and emergency department at Barnet hospital? There is

nothing new at Edgware hospital today that was not planned by the previous Government, although the accident services there now reside in what is called an urgent treatment centre. That used to be called the minor accident treatment centre, and the new name only confuses the public.
What the Conservative Government did in this sector is exactly the same as what the present Government are doing-when new facilities are built, old facilities are closed.

Ms Ryan: That seemed a very lengthy intervention, but I shall respond to the points that the hon. Gentleman made. He clearly said that the previous Conservative Government planned the closure of the accident and emergency department at Edgware hospital. Its subsequent closure is a matter of record. Moreover, the facilities at Edgware have been thought through carefully. What is different under this Government is that they are funded.
The hon. Gentleman and I have a connection, in that our two hospitals-Chase Farm and Barnet-now form a merged trust, with a wonderful, state-of-the-art accident and emergency unit. However, across north London, the hospitals include Edgware, Barnet and Chase Farm, North Middlesex, the Whittington and the Royal Free. The Turnberg report's assessment of the desirable number of new attendances at accident and emergency departments makes it clear that the department at Edgware was needed and that there was no reason to close it. A bottleneck has been created at Barnet hospital, and difficulties have resulted for north London's accident and emergency services.
However, those difficulties are being accommodated, and extra funding is being made available. There are new accident and emergency facilities at North Middlesex hospital, and the aim is to improve the facilities at Chase Farm. Yet that bottleneck and the resulting problems were in part caused by the decision that the previous Government took about Edgware.
I turn now to the merger of Chase Farm hospital and Barnet hospital. Once Chase Farm understood that its future was secure, we realised that there would be many advantages in merging with Barnet hospital. In November last year, we held consultations for the first time. People felt that they could discuss merger without suspecting, as they had before, that there was a hidden agenda involving the ultimate closure of one of the hospitals. They were thus able to talk about a positive way forward that would bring real benefits.
That consultation was a real exercise in rebuilding the trust between Government and public. People initially vented their feelings that the consultation that had taken 'place over the previous 15 years was either a smokescreen for further cuts, or merely an exercise in lip service. I think that we can prove that that trust has been rebuilt by showing that the future of the newly merged hospital trust is bright, and that it will continue to shine.
There will be benefits. The newly merged trust will save £500,000 a year, and that will go into patient care. There will also be clear clinical benefits for patients. We will be able to manage emergency demand at peak times much more effectively and ensure that waiting times for admission to a hospital bed are minimised. There will be opportunities to invest in new services, equipment and facilities.


All that is positive news for Chase Farm and Barnet hospitals. We welcome the appointment of Jenni Bowley as chair of the new trust and Liz Heyer as chief executive. We wish them well as they face a challenging and exciting agenda for hospital care in that part of north London.
The rest of the Government's programme for modernising the NHS for the millennium will benefit people in the Enfield and Haringey health authority area and in my constituency. Out of the £;21 billion investment in the NHS that the Conservatives thought foolhardy and unaffordable, the authority is receiving about £24 million extra. We are grateful for that money which will make a significant difference. We are pleased to have had an extra £550,000 for refurbishment and modernisation of the accident and emergency department.
We also benefit from what the Government are doing through the private finance initiative. A PFI development has been signed and will soon be delivered for the newly merged hospitals. It will be sited at the Barnet part of the Barnet and Chase Farm hospital and will provide state-of-the-art facilities for people in the area.
That is in stark contrast to Tory attempts at PFI, when £ion was spent on consultancy fees without a single hospital being built. The Labour Government will build the hospitals that the Conservatives merely promised.
As regards the NHS waiting list for Enfield and Haringey, 4,400 people are no longer waiting for operations. That reduction has been achieved despite a 4 per cent. increase in attendances at accident and emergency departments because local hospitals have reached and bettered the Government's targets. That major achievement for the NHS in Enfield and Haringey has brought real benefit to patients.
We hear a lot from the Tories about waiting times. Waiting list reductions bring reductions in waiting time. We have achieved significant reductions on breast cancer care and colorectal cancer care. Reduction of waiting times is related to reduction of waiting lists; they are not mutually exclusive. Our targets for waiting lists prove that we are willing to set measurable targets on what we say we will do for the NHS, what we will put in and what can be expected from it. But targets do not mean that we have no other objectives, or that they are independent of other desired outcomes. That would be nonsensical.
We have a strong story to tell, and I am happy to tell it. The people of Enfield, North are hugely relieved that the future of their hospital, linked with Barnet hospital, is ensured. They know that, when they need their accident and emergency department, it will be there. When they need admittance, there will be a bed for them.
Enfield community care trust is doing sterling work to ensure that mental health is not a Cinderella service in Enfield. An extra £910,000, courtesy of the Government, is going into mental health services. It will be spent carefully but well by the trust, which is efficient and well run. A Labour Government, founded the NHS in 1945 and a Labour Government rescued it in 1997. We have a lot to be proud of in the NHS. I am proud of all the work that local staff in Enfield and Haringey put in. If it were not for this Labour Government, we would have seen many more closures and a lot less funding across London and Britain nationally.

Dr. Jenny Tonge: Once upon a time, the people of Richmond had good GPs, a little hospital called the Royal hospital and social services delivered by their local council. It all seemed relatively simple and easy. If they needed secondary or tertiary care, they went to any of the many London teaching hospitals because in those days GPs could refer them anywhere.
Then the Royal hospital closed and we were told that we had to use Queen Mary's hospital in Roehampton. Several hon. Members have spoken about it. It was formed into the Richmond, Twickenham and Roehampton Healthcare NHS trust, which was rather difficult because it meant that social workers in my borough were dealing with three different district health authorities and two area health authorities. That made for great confusion and obfuscation between hospital, community and GPs about where patient care was coming from.
After a long fight—I empathise with the hon. Member for Romford (Mrs. Gordon) about candlelit vigils, mock patients on trolleys and petitions to Downing street—the death sentence on Queen Mary's hospital was passed by the Conservative Government. The Labour Government, in their defence, had no option but to carry on with those plans when they came to power, unless they could have dug up a huge amount of cash from somewhere, which they were unable to do.
My constituents are now left with a hospital service which consists of an out-patient service for one part of the constituency at Queen Mary's hospital, Roehampton, which is not in the constituency and is run by consultants who are based at Kingston hospital, which is on the borders of my constituency and relates rather more to that of my hon. Friend the Member for Kingston and Surbiton (Mr. Davey)—I hope that we will hear from him later, Mr. Deputy Speaker, if you call him. As a result, there is great confusion and I should like the Minister to take that on board.
The health service has never solved the problem of medical records. Patients are seen in out-patients departments and somehow notes get lost when they then have to be in-patients, or vice versa. I have never understood why we have this problem. I worked in the NHS for 32 years before I became a Member of Parliament and notes were always getting lost. It seems to me that we have two options: either we can go in for technology in a big way and call up patients' records on screen or patients can be responsible for their own records. Why on earth can that not happen? It happens in other countries and I fail to see why we cannot have our own records with us when we go to see a consultant or our GP. They can keep records too, if they want to, but at least some notes would exist.
The other big problem is that because of the shortage of nurses in the London area, many beds at Kingston hospital remain closed, despite valiant efforts by the chief executive to recruit nurses. Hon. Members may have read in the newspapers about nurses being recruited from the Philippines, and very good nurses they are too. Despite all those efforts, beds remain closed. Because of the demography of the constituency and that of Kingston, many beds contain elderly medical patients. We now have an added problem. At Kingston hospital, surgical consultants do not have enough surgical beds because such beds are blocked by medical cases. The consultants


are becoming extremely worried that, sooner or later, the royal colleges will decide that there is not enough surgery taking place at Kingston hospital and they will no longer accredit the hospital, which means that there will be no junior staff. That is how Queen Mary's hospital started to die about 10 years ago. I am extremely worried that Kingston hospital will suffer the same fate, if we do not do something urgently about funding and the nursing complement. We must ensure that the area has a comprehensive service.
In my constituency at present, patients go to Queen Mary's or Kingston for out-patient treatment and they go to Kingston, St. George's or Chelsea and Westminster hospital for in-patient treatment. The mental health services have been transferred to Kingston and the district community trust. The trust has already stated that 20 beds for the elderly mentally ill will be closed-that is exercising me a great deal. The Twickenham community health service has been hived off to the primary care group in Twickenham, which is excellent news. As the community health services in Richmond were part of Queen Mary's, Roehampton, they have been merged with the Merton, Sutton and Wandsworth community trusts. If hon. Members are a little confused, they should imagine what it is like to be a district nurse, social worker or GP in my area, who is trying to work out exactly where the services have gone and where they can be accessed for patients.
That leads me to a general point: people in the health service are entirely sick of being reorganised. I hope that the Minister takes that fact on board-indeed, I know that she will do so. We have been reorganising the health service since 1974-major and minor reorganisations. Each chief executive who takes up his post undertakes a whole reorganisation of the staff under him. The staff of the health service expend all their energy, innovation and intelligence trying to cope with management changes, when they should be dealing with patient care. I make a plea for an end to further reorganisations.
In my area, luckily we have extremely good GPs. I very much welcome the formation of primary care groups; I think that they could be the answer. They could certainly be the answer to achieving that magic quality of coterminosity, which my area has failed to achieve in 25 years of health service reorganisation. Good primary care groups, running their own community health services and liaising even more closely with social and mental health services, could be the answer. Such groups are a brilliant idea; I hope that they are very successful and I congratulate the Government on introducing them.
However, I have some worries. Although NHS Direct and walk-in health shops are a good idea, I think that some GPs consider that those services might undermine GP services. I hope that, in time, the Government will try to merge NHS Direct and the walk-in health shops with the primary care groups. Perhaps the Minister could address that point in her closing remarks. GPs need and deserve to know what is happening to their patients, and who is responsible for their care. Is it the GP, the doctor in the walk-in health shop or the NHS Direct nurse at the end of the phone line? That matter must be addressed, because we need co-ordination. At this stage, money for the formation of those groups could have been much better spent on GP services.
I promised to be brief and I want to deal with two other aspects. The document setting out the goals for the modernisation of the health service in London states that

London leads the way nationally in specialisms and expert care. Of course it does. However, there is a problem that I hope that the Government will address. The hon. Member for Ruislip-Northwood (Mr. Wilkinson), who is no longer in the Chamber, raised the issue of a hospital that is brilliant at one service, but depends on another service for its brilliance. He asked how far one could actually separate them. I do not think that the hon. Gentleman's example was a good one, but I know a better one, involving a hospital very close to this place.
The hospital has a major trauma centre, but no longer has a neurosurgery unit. As the House knows, trauma centres usually take large numbers of head injuries, which often require neurosurgery, but the neurosurgery unit has been moved to another hospital several miles away. Because of that, neuroradiology-the specialty that attempts to find out what is happening inside the head and spine before the surgeons go in-has become unpopular in the hospital and the consultants have moved elsewhere. The result is a major trauma unit that cannot provide a good head injury service, and that worries me.
There are countless other examples of interrelated services, one of which is that maternity services have to be close to paediatric services-they must be in the same hospital. It is a source of concern that, as hospitals become centres of excellence and concentrate on one specific service or another, which is good in its way, we shall lose the combination of services that is essential to patient care. I hope that the Government will address that issue.
I heard yesterday from a group of senior managers that, despite the apparently magnificent extra funding that the Government are giving to the health service-I think the figure is £21 billion over three years, but I cannot be sure; it is like my own income, which is spent in several different directions at once, and I never know where it has all gone-most health authorities expect to be in a standstill position this year. That is because of pay awards and the extra money that they have been given being ring-fenced for specific projects, such as breast cancer services. Those projects are all worthy of our support, but they might not have been each health authority's priority this year. Because the health authorities will be at a standstill, we shall not see huge improvements or people rushing out into the streets saying how wonderful everything is and how they do not have to wait long for treatment any more.
We must take a serious look at what we set up in 1947, because the problems of the health service will never be solved by reorganisation or small amounts of funding. We need huge hikes in funding and we have to decide whether that will come from general taxation or some other source. The health service needs far more than what the Government are providing at the moment. The health service was created to cater for us from the cradle to the grave. Then, it had to cater for us from the womb to the tomb. It subsequently had to stretch its resources from the sperm to the worm. Now-I am glad that the Secretary of State is no longer here, because I have already told him this joke, which is far better than his-the health service has to cater for us from erection to resurrection. That cannot be done-we have to find another way.

Mr. Clive Efford: In deference to the hon. Member for Macclesfield (Mr. Winterton), who was not present for the speech of the hon. Member for Rutland


and Melton (Mr. Duncan), I should like to read out a list of hospitals that have closed in the borough since 1979. The hon. Member for Rutland and Melton made a great deal of closures that were set in train by the previous Administration, but took place after the election of this Labour Government.
The British Hospital for Mothers and Babies was closed, as were the St. Nicholas hospital, the Eltham and Mottingham cottage hospital and the Brook hospital; and units dealing with the cardiothoracic and neurosciences specialties were both closed-all closed when the Conservatives were in government. The decision to close the Greenwich and District hospital was also taken at that time, and the decision to close Guy's hospital was announced just as a brand new building to house important research into cancer and other illnesses had been completed. We then had the discredited Tomlinson report, which recommended that we should lose acute beds because London was over-supplied. Tomlinson justified that recommendation on the basis that top-slicing money from acute services and investing it in primary care would lead to less demand on acute services in hospitals. However, when one devotes money to health areas where access is somewhat diminished, one begins to identify greater need for acute services and secondary and tertiary health care. It was a con to recommend that money be top-sliced from acute services and ploughed back into primary care before we had the opportunity to gauge the effects or the benefits, and it cost the people of London dearly.
That is the situation that the Labour Government inherited: the national health service was definitely under seige. I pay tribute to the staff of the national health service not just for the way in which they responded to the three recent bombings in London, but for their dedication to the health service while it was under seige. While claiming to protect the NHS, the previous Government were trying to dismantle it. It is only the dedication of the doctors and the nurses that held the NHS together so that a future Government could develop it as this Government are doing.
I welcome the initiatives that have been set in train. Primary care groups will bring decision making about local health services closer to the communities. I have argued and campaigned for that move for many years. I am a former chair of a social services committee and a former member of a community health council and a district health authority. I believe that we will see further improvements in planning and in the quality of health care when people from social services sit around the table with GPs, nurses and the lay people who use those services and devise local care strategies.
I totally opposed fundholding, and I remain concerned about the changing role of the GP in relation to patients. Prior to fundholding, GPs were patient advocates. Fundholding made them the gatekeepers of the resources. GPs had a vested interest in reducing access to resources in many instances. Primary care groups must guard against making GPs fund managers rather than planners and advocates on behalf of their communities. GPs will play an important role in leading community discussions as qualified professionals, in developing health care

strategies and, at times, advocating additional resources rather than cuts. Primary care will need to develop in order to provide a wide range of services.
There is another important issue regarding waiting lists and the care of patients awaiting treatment in hospital. I would like to see more transparency in terms of performances in hospitals, particularly by consultants. I talked recently to a chief executive who described the disparity between the work rate of consultants in an NHS hospital and their work rates in private practice. He also expressed concerns about the relationships between local GPs and particular consultants, and how certain consultants are favoured when GPs make referrals.
The chief executive told me that trusts and providers must act as the gatekeepers for people who are referred to consultants because there is a clear relationship between the size of consultants' private practices and the size of their NHS waiting lists. I realise that that is a generalisation, and I would not suggest that it is true of every consultant. Frankly, however, some of them are behaving like spivs. They say to patients, "I cannot treat you in the next year, but if you cross my palm with silver, I will treat you a week next Tuesday." People on NHS waiting lists are forced to pay for treatment by consultants, and they often see in private practice the same consultant whom they would have waited to see in the national health service.
There should be more transparency on that matter. We have league tables in many areas of public service, so why not for individual consultants? They earn a great deal of money out of the national health service, and there should be performance statistics that not only detail how many operations they carry out within the NHS, but account for what they are doing in the private sector, so that we know their performance rates.
I was cited an example about eye operations. In the NHS, surgeons would perform five or six operations in a session, but, in the private sector, the same consultants would perform nine, 10 or 11 operations in the same time and, in addition, carry out pre-med duties and wheel the patients into the operating theatre to increase the throughput. Incentives must be offered so that such productivity is mirrored in the national health service.
I am aware that other hon. Members want to speak, so I shall be brief. We are about to elect a mayor for London. Someone with such a high profile in a capital city has a major role to play in public health campaigns to improve health and the understanding of health issues across the city.
We need to take more action in schools. I know that we have started that process, but we need to give young people more practical education about the simple facts that we all should learn in our day-to-day lives. I refer to matters such as the storage and cross-contamination of food and the treatment of minor illnesses. The technology and information exist to allow people to take better care of themselves, and young people are certainly capable of accessing that knowledge. If people understand more about their ailments, fewer demands might be placed on the health service.
My local health authority is trying to organise an international conference on health care issues, and its endeavours have the support of the Department of Health. As the authority is responsible for the Greenwich area, it will not surprise anyone that the event will be called the


millennium conference. It is designed to increase young people's awareness of health issues across the world, so that they will return to their communities and become advocates for better health care. It will also be an opportunity for young people to learn from one another about the issues that confront communities across the globe.
One of the issues that we need to address in future, of which I know the Government are aware, is the provision of better health information. Knowledge can help to reduce the demands made on the national health service because people are then able to take better care of themselves and one another, and within that process, emphasis must be placed on educating young people.

Mr. Peter Brooke: I normally have the pleasure of listening to the hon. Member for Eltham (Mr. Efford) speaking about his experience as a taxi driver, so it is a very great pleasure to hear him on another subject on which he is just as fluent.
I congratulate the Government on providing this debate today. I am not one of nature's great modernisers, although I would not go so far as the Scottish judge who said that change for the better was a contradiction in terms. Such days as this, which are dies non for the larger House because of the constituency imperatives on a polling day that take Members away from here, afford so great, if so narrow an opportunity that I have a practical suggestion to make to the Modernisation Committee.
Since these days are likely to be given to geographical subjects—because some Members are away from the House—I hope that there might be a virtue in reserving them further ahead than the usual fortnight's notice, so that Members know that the debate is coming up. Today's subject is complex, as the great weight of King's Fund reports that gather on one's shelves testify. It is a problem not just to accumulate the data, but as, I fear, one or two speeches have demonstrated, to organise, distil and refine such data. If we have more time to prepare, the debate would be even better than this one.
My constituency references will be brief, but like the dodo in "Alice in Wonderland" there is a prize-giving aspect to the occasion. I shall not seek to match the Secretary of State's encomium on the recent emergencies, which he gave eloquently and wholly appositely. His praise was intensely well warranted and, in turn, a tribute to the well-rehearsed preparation of various national health service institutions.
On a longer-term basis, in 1998, we had in the Kensington, Chelsea and Westminster health authority much the lowest proportion of patients waiting for 12 months or longer of the 16 London health authorities. On the other hand, in 1997, it had the second largest proportion of single-practitioner general practices, at 56 per cent. It was thought that that figure would fall following the closure of Westminster hospital, but, if it has, it remains high and an inner-city phenomenon.
At the other end of my constituency, 11 per cent. of the 564 most deprived electoral wards in England and Wales are in the East London and The City health authority. In that context, it was warming that the Turnberg report singled out the health authority's communication strategy for special and particular praise. I am personally proud

that Sir Brian Jarman, who is historically linked to St. Mary's, co-produced the Turnberg report and has done such path-finding work on bed use, should be professor of primary health care at Imperial College school of medicine.
Apart from the dodo's prize giving, I must say a word about Bart's, on which there was a mini-clash between my hon. Friend the Member for Rutland and Melton (Mr. Duncan) and the Secretary of State during the opening overs of the debate. I am personally delighted not only at the Secretary of State's decision following the Turnberg report, but at the fact that he is riding herd on the dispositions of Bart's through the appointment of external arbiters.
The papers of yesterday's board meeting of the Royal Hospitals trust give pointers to why there continues to be local concern, to which my hon. Friend the Member for Rutland and Melton made reference. The outline business case for the new hospital at the Royal London and the redevelopment of Bart's was due to receive approval at yesterday's meeting, only to be delayed by further guidance from the regional office on the development of cancer services at Bart's. There is to be an intensive programme of work over the next few weeks to define which services are required in a centre of excellence at Bart's. I could not possibly complain about that, but the path of true love in east London does not seem to have run entirely smoothly.
Bart's leads me more smoothly to the configuration of medical schools in Greater London. Labour Members tend to be critical—I remark neutrally—in what they say about what happened in the NHS in Greater London during the first 18 of the past 20 years. In that process, they omit to pay credit to the reorganisation of London medical schools in the university of London. I should, incidentally, declare an interest as a member of the council of that university. The Flowers and Swinnerton-Dyer reports, early in my time in the House, may seem to belong to another age to those who came into the House in 1997, but they are worth revisiting to realise the scale of the revolution that has since been carried through.
As Turnberg says, 70 per cent. of all research and development expenditure allocated to medical schools by the NHS executive goes to the London schools and 42 per cent. of all medical undergraduates in England are trained in London. He also points out that there can be disadvantages for local services in such a concentration of academic excellence in medical schools.
Other colleagues have no doubt had representations from medical students about the creation of a new medical school nationally. I am making inquiries privately of the Department for Education and Employment and the Department of Health. I am in no way making a bid for another London school, but, were there to be one nationally, it would relieve strain on the London schools. Any light that the Minister can shed on that when replying to the debate will be welcome.
I hope that the London rationalisation will continue. I can remember a conversation at Bart's 22 years ago when the Bart's element at the occasion thought that Greater London could manage with, for example, three centres of excellence in neurosciences. The fact that Turnberg reports on 11 centres in neurosciences being reduced to six is an index of how far we may still have to go.


The Secretary of State alluded to the link between poverty and deprivation and the quality of health and advanced a claim that the Government were addressing the poverty and deprivation in the interests of good health. Looking round the Chamber, I cannot recall immediately whether anybody else present today was present for a recent interesting statistical analysis given by the Economic and Social Research Council in Room W 1 off Westminster Hall on the link between poverty and health. Health was measured by morbidity, whether average or below or above.
Broadly speaking, the ESRC had one table for the 1980s—the tables were calculated by current constituencie—and another for the 1990s to date. My constituency and that of my parliamentary neighbour, the hon. Member for Regent's Park and Kensington, North (Ms Buck), who I see in her place, came in the top 50 poorest out of the 659 by household indices of poverty. The hon. Lady's constituency came high in the list for ill health in both decades and tables. Interestingly, my constituency, which is an inner-city seat—perhaps the ultimate inner—city seat-has jumped from being in the top 100 illest in the 1980s to being in the top half for good health in the 1990s. That was so sharp an improvement that I drew it to the attention of the ESRC, which is separately conducting an investigation.
One contributory reason I have suggested to the ESRC is the arrival of asylum seekers. At the time of Turnberg, 85 per cent. of those granted refugee status had settled in London, with the majority in inner London, and there were 100,000 in London who were either refugees or awaiting confirmation of refugee status, with still larger numbers today. Those refugees are likely to be poor but, on average, they are likely to be younger than the general population they have entered.
I mention that study in the context of the Secretary of State's claim because the ESRC was not so sanguine as the Secretary of State today that the Government were concentrating resources in the poorest constituencies. As a veteran reader of the Black report, which came out at about the time I first came into the House, I was agreeably surprised when the ESRC, when making its presentation, was comparatively warm about the way in which the Conservative Government, by comparison, had targeted resources in that context.
In the same spirit, I want to talk about measurement, accounting and economic inputs. I well remember how few accountants British Telecommunications had when it was a corporation in the public sector. The national health services's accounting was similarly primitive when I first came into the House—incidentally, under a Labour Government—and, as I have said previously, that cost my constituents severely. The resource allocation working party—RAWP—was taking money out of London and the accounting system was rewarding us slowly, and less than adequately, for services that hospitals in inner London rendered to non-London residents in expensive operations where payments were calculated on the basis of average rather than actual cost. I hope that that situation has improved latterly and that the Minister can now sleep at night over the accuracy and fairness of the accounting.
I am, however, concerned about what the Turnberg report said about under-enumeration for the capitation formula; and I can personally believe in that concern.

Over and above the homeless, the mentally ill and the refugees—all of whom Turnberg deals with—in my constituency mail, proportionally, I receive two letters from residents in my constituency who are not electors for every five that I receive from those who are electors. That suggests to me that there may well be under-enumeration.
Although the Secretary of State, at the beginning of the debate, sailed serenely through the brush on low pay, I shall remark anecdotally—as an occasional out-patient at a teaching hospital, where I see a specialist of high reputation, at his clinic—that the paperwork of appointments is a nightmare for both of us. I am booked for one date; hear nothing further; then am told that I have missed another date; then discover that the date I had originally been given is one on which the specialist is on holiday.
I make no complaint about that at all. I am not seeking special treatment. It is a very good way of finding out what one's constituents themselves have to experience. The specialist puts it down to what the NHS is able to afford to pay clerical assistants. However, it is not conduct that commands respect, and it must be economically inefficient for the consultant, for his patients and for the NHS as a whole.

Mr. Mike Gapes: It is always a great pleasure to follow the right hon. Member for Cities of London and Westminster (Mr. Brooke), who entertained us greatly when we were considering the Greater London Authority Bill. Today, he has raised some interesting issues. Although it is tempting to pursue some of them, I have a specific constituency interest to deal with.
First, however, I should like to raise one other issue for the Minister to address in her reply. As she will know, some months ago, I raised it also with my right hon. Friend the Chief Secretary to the Treasury.
What is being done to tap London's great resource of refugee doctors? My health authority—Redbridge and Waltham Forest health authority—and particularly Dr. Peter Elliott, who works for it, have introduced an innovative scheme to try to train in English and help gain accreditation for refugees with medical expertise or who have worked as the equivalent of general practitioners in hospitals in their own countries before being forced to flee to the United Kingdom. Currently, it is difficult for them to gain accreditation.
I hope that the British Medical Association and other authorities, with the Government's assistance—not only the Department of Health, but the Home Office will have to become involved—will facilitate the employment of refugee doctors, particularly in serving refugee communities where their linguistic skills and cultural understanding would be of great help.
I shall concentrate my remarks, however, on the specific issue that was dealt with at some length in the speeches of my colleagues and neighbours from Redbridge and Havering: the new hospital at Oldchurch, which was pushed for by Turnberg, and endorsed by the Secretary of State in accepting Turnberg's recommendations.
The Turnberg report was submitted to Ministers in November 1997, and the Secretary of State responded to it on 3 February 1998. On that date, I asked him for an


assurance that development of the new hospital would not have a detrimental effect on the King George hospital—in Ilford, in my constituency—which is only about 3.5 to 4 miles from the proposed site of Oldchurch hospital.
The Secretary of State told me:
I assure my hon. Friend that there will be thorough local consultation and that any decisions will take account of the possible impact of a new hospital at Oldchurch on neighbouring hospitals. I reassure him that our objective is to build up, not run down, London's hospitals."—[Official Report, 3 February 1998; Vol. 305, c. 858.]
I very much welcomed that statement then, as I still do. However, some issues have not been resolved, and the Redbridge Health Care trust and the local community still have some concerns.
The King George hospital is relatively new. It was opened less than six years ago. In that time, the level of activity at the hospital has increased enormously. When it was built, it was planned that there would be 55,000 accident and emergency attendances a year. In 1998-99, there were 90,000. Elective work is double what was planned, and there has been a 49 per cent. increase in emergency work.
The hospital has also had a lot of new investment, with £7.5 million of further capital to develop essential departments and support in pathology, radiology, cardiology and sterilisation services, as well as a new computer linking system with information, advice and facilities for downloading tests for general practitioners. The hospital has put a great deal of effort into its relationships with local GPs. I am pleased to say that, in the past year, waiting lists have fallen by more than 30 per cent., which is, as they used to say in eastern Europe, over-achieving the target. The waiting list situation was not good, but there has been a significant improvement.
Three, four or five years ago, I was critical of my local hospital. At one point, I called for a public inquiry because I was getting so many complaints from constituents about how things were going at the hospital in 1994 and 1995. There has been a significant improvement at the hospital in recent years. I pay tribute to the staff—the nursing and medical staff and the ancillary staff—and to the management of the hospital for the improvement that they have brought about. I receive far fewer complaints about my local hospital than I did when I was first elected to Parliament seven years ago. Of course, there are still complaints, as there will always be with any hospital, and they have to be dealt with properly.
The trust has brought in new ways of workingday—case surgery, overnight day-case systems and opening the unit on Saturdays and Sundays—to deal with the problems. The hospital is now effective, very busy and very popular. It needs to continue the work that it is beginning to do so well. My hon. Friend the Member for Upminster (Mr. Darvill) pointed out how the final decision on Oldchurch was causing uncertainty. As well as affecting the people of Upminster, Hornchurch and Romford, that uncertainty causes problems for the King George hospital in Ilford. The new investment that our hospital needs will be affected by uncertainties and delays at the new hospital. The uncertainty surrounding Oldchurch is making long-term planning more difficult.
The greater co-ordination and discussion between Redbridge and Waltham Forest health authority and Barking and Havering health authority have been

important developments. There have also been contacts and discussions between the trusts. I welcome that. It would be absurd if trusts competed with each other rather than working together to serve the interests of the local community and patients. Turnberg called for such co-operation and opportunities for collaboration. That is all to the good, but I reiterate my initial point about the importance of there being no uncertainty about the future of the King George hospital as the new hospital at Oldchurch is developed.
There are still concerns among the local community, many of which may be unjustified, but uncertainty may lead to difficulties in future. The argument does not relate to money, egos or competition between trusts. Anyone with any knowledge of the medical profession and the way in which hospitals work will know that any institution requires a certain level of achievement to make it fully viable in terms of the number of junior doctors who are attracted to work there and the number of specialisms that it offers. Increasingly, clinical services are being developed whereby hospitals require a certain volume of patients to maintain the quality of work—doctors need to do a certain number of a particular type of operation in order to keep their hands in.
My worry, which is widely shared, is that a consultant-driven approach may be at variance with community need. We need to get the balance right. It is not just a matter of resources; there must be a balance within the service so that hospitals are viable and attractive. We do not want any one hospital to act as a magnet for the best consultants and people with career aspirations so that other hospitals are regarded as declining backwaters or as failures.
As we develop new facilities, we need to recognise the needs of the existing ones. That view is widely shared by hon. Members on both sides of the House, but it needs reiterating.
Strategic planning and co-operation are very important. As the constituency Member for the King George hospital, let me say that it is vital that elective surgery is not moved away, that the new hospital at Oldchurch fulfils the requirements of its community, and that the two hospitals work together in partnership, as that will be important for the future. The new development must not compromise the future viability of the existing hospital. I am confident that it will not, but my constituents in Ilford want that assurance.

Mr. Edward Davey: I start by associating myself with the remarks of my hon. Friend the Member for Richmond Park (Dr. Tonge). With her experience of more than 30 years spent working in the health service, she analysed the problems that we have in south-west London, and particularly at Kingston hospital, very well.
I am also grateful to the hon. Member for Putney (Mr. Colman), who is no longer in his place. He referred to the problems at Kingston hospital and gave it his full support. Many of his constituents use it; it is a vital service for them, as it is for my constituents. I am particularly delighted that the hon. Gentleman has become convinced of the need for new investment in the accident and emergency department. However, I do not share his belief that the health authorities of Merton, Sutton and


Wandsworth should merge with Kingston and Richmond. That view was not mentioned in the Turnberg report; nor was it shared by those in the local health authority whom I met.
As time is short, I shall limit my remarks on the wider modernisation agenda, save to focus on one or two technological developments in my constituency. Agora Healthcare, a local software firm—I should say for the record that I have no financial or other interests in that company—is working with a local GP practice and the Kingston hospital to see how they can use information technology to integrate primary and secondary health care to reduce waiting lists. That is a technological development in which the Government ought to be interested.
The company is running a pilot project in a local GP's practice, sending digital photographs of dermatological conditions on-line to the consultants at Kingston hospital to see if they can speed up the process and improve the medical outcomes. By the company's calculations, if the project—which is proving its efficacy—were to be rolled out across the country, it would immediately hit the Government's reduction targets for waiting lists. I commend the pilot to the Minister.
Technological solutions would help in the structural changes in south-west London. My hon. Friend the Member for Richmond Park mentioned the problem of clinical records being lost, and we are concerned about that in the secondary sector. Some consultants saw a patient at the old Queen Mary's site at Roehampton and again later at Kingston. There is a need to improve communication between the two sites and to make sure that the records can be easily accessed from both. That would improve the attractiveness of Kingston hospital as a place to work, as well as a place to be treated.
My hon. Friend the Member for Richmond Park rightly referred to the problems of staff shortages at Kingston hospital. The closure of Queen Mary's has made it worse. I wish to praise the staff of Kingston hospital, who have been working flat out because of the pressure—pressure which is over and above the national pressure about which we have heard today.
The transition from Queen Mary's has been difficult. Turnberg referred to the need for local health managers to have a credible plan for the transition. In an Adjournment debate last spring, I warned about the need for that plan to ensure that we did not suffer huge bed shortages during the summer and autumn of 1998. I am pleased to say that, following those warnings and work with the Government, the bed shortage did not occur. The Roehampton wing was put up on time at the Kingston hospital site, which was good.
There have been problems in the transition, not so much with buildings, as with staff shortages. Despite the best efforts of management, a lot of the staff did not transfer from the Queen Mary's site to Kingston—as the hon. Member for Putney mentioned—partly because of the London salary weightings and the lack of creche facilities at Kingston. However, they were also fed up with and demoralised by the way in which Queen Mary's had been run down over a number of years. They felt that the last change was the straw that broke the camel's back, and they were not prepared to go along with it. Many

patients and much of the health demand transferred to Kingston, but Kingston did not get a lot of the staff. That has exacerbated the staff shortages locally, and there is still a major hangover from the change.
As my hon. Friend the Member for Richmond Park said, the management of Kingston hospital went over to the Philippines to recruit, and they recruited some excellent nurses. However, it seems absurd that they had to go to the other side of the world to find staff to work in the health service in south-west London. That raises wider issues of pay and training; and there is a feeling that, at Kingston hospital, the transition was not supported as much as it should have been.
Locally, some GPs have not felt that, in the first year of the transition, they could refer patients to Kingston hospital whom they previously referred to Queen Mary's. The statistics show that the transfer of patients has not been as large as was expected prior to the closure of Queen Mary's. That is purely to do with the staff shortages. GPs tell me that, once enough staff are in place and the investment has been made in the space, they will start referring their patients to Kingston.
Investment is urgently needed in Kingston hospital. Comparing the year before the closure of Queen Mary's, 1996–97, with the year 1998–99—the services were transferred from April 1997—we find a massive increase in the work load at Kingston hospital, with 15 per cent. more people attending accident and emergency, a 60 per cent. increase in in-patients and a 71 per cent. increase in emergency in-patient cases. That has created huge pressure, and it is vital that the management should be backed up in the effort to tackle it.
The hon. Member for Putney was right. The investment in the accident and emergency department is crucial. The Secretary of State said that £100 million was available for small improvements in London. Investing in accident and emergency at Kingston would be not only a small improvement for my constituency, but a major improvement for the whole area. I hope that the Government will give their backing to the hospital's long-term future.
There are many good developments in the health service in south-west London. The primary care groups have taken off well in Kingston and I wish them well. Many local people have been involved in campaigns to improve local GP practices and medical sites in New Malden, Surbiton and Chessington, for example. I pay tribute to Chessington councillors who, working with developers, have ensured that land is available for a new medical centre there and that the developers will provide a subsidy to link it to Kingston hospital with new public transport services.
Kingston and Richmond health authority has had below average funding increases for some time. The national average cash increase for the next financial year is 6.6 per cent., but in Kingston and Richmond it is 5.5 per cent. In real terms, the national average is 4.4 per cent., but Kingston and Richmond is getting only 2.9 per cent. Local health managers are concerned that, if that trend continues, they will be really stretched.
The Secretary of State rightly said that the Government should direct resources to where they are most needed—the Government are right to tackle inequality in health care—but sometimes Ministers, not only in the Department of Health, but in other Departments such as


the Department of the Environment, Transport and the Regions, look at a place such as Kingston and dismiss its needs because it is leafy.
If Ministers came to Kingston and travelled around the constituency, they would see that many parts are not leafy at all. There are pockets of severe deprivation. Norbiton ward, for example, is one of the poorest in the whole of London. Poverty exists in the royal borough. We have below average wages for London. If resources are to be allocated to redress inequality, I hope that Ministers will consider not only the macro-picture but some of the micro-measures.
Some of the statistics that are often used do not give a fair reflection of the poverty in constituencies such as mine. The measure of free school meals is an example. Because the previous Conservative council ended the hot meals service in schools, many mothers on income support whose children would otherwise have a free meal no longer claim their entitlement, because they do not want their children to have a cold meal.
I am concerned about the suggestion by the hon. Member for Putney that Kingston and Richmond health authority could merge with Merton, Sutton and Wandsworth. I urge Ministers not to go down that road, not only for the reason so eloquently expressed by my hon. Friend the Member for Richmond Park—that it would mean another management upheaval, another bureaucratic change—but because it would create a mega-bureaucracy, thus reducing both the flexibility of the management of local health services and the focus on the health needs of the communities that my hon. Friend and I represent.
Such a merger would prevent managers from focusing on the real priorities in Merton, Sutton and Wandsworth, as well as in Kingston and Surbiton. The hon. Member for Wimbledon (Mr. Casale) talked about the merger between the Pathfinder mental health trust and the Sutton mental health trust, but I think that that was a retrograde step for the mentally ill people who were using the Sutton services. They had much more in common with the Kingston and Richmond services, in terms both of those who were delivering the services and of the types of need. That emphasises my point that pushing together bureaucracies does not necessarily achieve a focus on the needs of local communities.
There is much more that I could say, but I am conscious of the fact that several Labour Members want to speak, so I shall finish by saying that, although a lot of what the Government are doing for health in London is welcome, I hope that the Minister will forgive me if my judgment and praise are reserved until we hear the decision about investment in Kingston hospital. That investment is much needed, and it cannot come too soon.

Ms Karen Buck: I congratulate the Government on a solid record of achievement in the two years since the election. We have now seen the beginnings of the dismantling of the internal market in the health service, which was so bureaucratic and divisive, set hospital against hospital and created a two-tier service in primary health care. Patients were often treated not on the basis of clinical need, but according to whether they had a GP fundholder.
We now have London's largest ever hospital building programme. The comprehensive spending review has provided not only generosity in investment in the health

service, but a three-year funding package which provides security—in contrast to the squeeze-and-spurt process that characterised the years of Conservative government, when a generous pre-election investment would be followed by a tight squeeze after the election.
We have more new initiatives, which have already been well described by my hon. Friends. For example, there is the sure start programme, run with the Department for Education and Employment, and NHS Direct. I shall limit my enumeration of the Government's virtues only because time is limited and others wish to speak.
I shall make four points. First, on the subject of health inequalities, I congratulate the right hon. Member for Cities of London and Westminster (Mr. Brooke) on having so eloquently made the case about poverty and deprivation in central London. The Government, too, are to be congratulated on the commissioning and publication of the Acheson report into health inequalities, which laid out an excellent strategy for tackling many of the problems that underpin poor health.
What the Government have done stands in stark contrast to the handling of the Black report, which the right hon. Member for Cities of London and Westminster also mentioned. That was an excellent document which, had it been implemented when it was published, would have prevented many avoidable illnesses and premature deaths. Shamefully, it was suffocated at birth, which was typical of the Conservative Government.
I shall make another point about primary care, which was also mentioned by the right hon. Gentleman. The Opposition spokesman, the hon. Member for Rutland and Melton (Mr. Duncan), talked about single-handed GP practices, which he, unlike the right hon. Gentleman, favoured.
Inner London has a staggeringly high proportion of single-handed practices. Although people naturally want to relate to an individual GP, and know his or her name and face—that can be a problem for group practices—single-handed practices undoubtedly do not provide the same quality of patient care, especially out-of-hours care which is so important. That is definitely one of the factors underpinning the inappropriate use of accident and emergency departments that is a feature of inner-city life.
Excellent models of co-operative working are now being developed in the primary health care sector. In St. Charles hospital, the GP co-operative has done excellent work in bringing together GPs to work co-operatively to provide 24-hour care. GPs working alone or in small practices face a heavy burden in providing out-of-hours care. The Government should be congratulated on elevating primary care to a central role in health care, as exemplified by primary care groups.
I welcome the inclusion of the development plans for St. Mary's, Paddington in the provisional three-year development programme set out in the Government's response to the Turnberg report. The hospital is situated in the constituency of the right hon. Member for Cities of London and Westminster, but I am sure that he will appreciate that it is my local hospital, too. The plans that have been drawn up by St. Mary's for the next phase of development are exciting and positive, providing an opportunity for the reconfiguration of specialist services across west London and fitting in with the exciting Paddington regeneration scheme. I hope that those plans will be considered favourably by the Minister.


I pay tribute to the leadership of the St. Mary's trust, under the still relatively new trust chairman, Trevor Campbell-Davis, who is an efficient, effective and dynamic leader. He was instrumental in turning around the St. Charles hospital in north Kensington, which was in a poor state a decade ago, but which has changed dramatically and now makes a valuable contribution to the quality of care for north Kensington residents.
I welcome the fact that the Government have published a coherent strategy for mental health care services in their response to Turnberg and in the Green Paper on mental health services. The Government have backed that up, as my right hon. Friend the Secretary of State said, with £37 million extra for health and social services psychiatric provision. How desperately we needed that money. Psychiatric provision—especially acute psychiatric provision—was woefully inadequate by the early 1990s.
One of the most awful features of London health care in the 1980s and 1990s was how often severely mentally ill people spent the night in police cells because there was no secure acute psychiatric accommodation for them. On occasion, people were driven out of the capital, away from whatever support services they needed, to secure psychiatric beds in places such as Chester, Brighton and Southampton. That situation needs to be turned round.
The Turnberg report and the mental health services Green Paper set out a strategy based on investment, improved care processes, an improved legal framework and a recognition of the inadequacy of the past implementation of community care. That strategy is coherent, thoughtful and backed with resources. However, I ask the Minister, who is fully committed to delivering on the issue, to help to ensure that other Departments and local authorities provide essential support for the strategy. The need for a co-ordinated, multi-agency approach to mental health care services remains critical, as highlighted by the recent Dixon inquiry into the murder of PC Mackay by a severely mentally ill man under the care of Kensington, Chelsea and Westminster health authority. It is appropriate at this moment to pay tribute to PC Mackay, and the other police and front-line workers who so frequently put themselves at risk of attack and murder by members of the public who have severe mental health problems.
The Dixon inquiry revealed serious weaknesses in police and management that those authorities—to their credit—have embraced and are beginning to implement. Underpinning all that is the desperate need for an adequate reflection of London's problems in all the funding settlements, some of which were mentioned by the right hon. Member for Cities of London and Westminster when he talked convincingly about the under-enumeration of vulnerable groups.
The incidence of psychiatric morbidity in central London is four times the national average, and schizophrenia is three times more prevalent than nationally. One third of mental health service users in central London either are homeless or have no local connections. As the Acheson report found, 45 per cent. of bed-and-breakfast occupants experience severe psychological distress, compared with 20 per cent. of the general population. As the Dixon inquiry highlighted, there are 183 severely mentally ill people in bed-and-breakfast accommodation in one borough alone. That is untenable, and we must ensure that action is taken to prevent that situation from continuing.
The social exclusion unit and the rough sleepers unit are doing excellent work, in partnership with Government Departments, in dealing with a lethal cocktail of mental illness, homelessness and substance abuse, after those problems had been neglected for years. However, it is early days: the need is desperate and we must do everything in our power to stop people who are severely mentally ill being put in bed-and-breakfast accommodation.
Social housing to provide care for those people—especially for those who are single—must be fairly distributed across London. We must resist the pressure that has built up over recent years—certainly in Westminster—to create psychiatric ghettos in poor corners of the city. They can only add to a problem that is already serious, both for those who suffer from mental illness and for the wider community. I look forward to my right hon. Friend the Minister's response.

Mr. Gareth R. Thomas: I, too, welcome the opportunity to debate London's health service. The reforms in the Health Bill—especially the abolition of fundholding, the replacement of the internal market and the emphasis on quality—are long overdue. The focus on promoting partnership across health care boundaries will also be welcomed by Londoners.
The Conservative Government's stewardship of the national health service in London had, by May 1997, produced waiting lists at record levels and an internal market that fostered competition, inefficiency and chronic under-investment in patient care.
In the very worst cases, the internal market generated a form of bureaucratic imperialism, as a few chief executives of trusts sought to gobble up the activity of neighbouring trusts to bring in new streams of income, often at the expense of quality and ignoring local concerns. The crazy merger of Watford general hospital and Mount Vernon hospital was one such example. They were very different hospitals in terms of their clinical specialties: one looked to help patients in Hertfordshire, the other served people in London.
The merger involved a highly destabilising revolving circle of senior executive staff, and an increasing loss of transparency and local accountability in the trust's finances. Ultimately, it led to the loss of Mount Vernon' s status as a district general hospital and the closure of its accident and emergency unit. Those two decisions have had a disastrous consequences for the remaining services on site, as other hon. Members have noted.
Divisive and destabilising competition was the product of the structure that we inherited, but quality must be the motor of the new structure for London's health service. Quality cannot somehow be imposed. We cannot magic it into hospital processes: it is not the concern only of the royal colleges or of those hospitals where poor standards of care have been identified.
A commitment to quality is, first, a state of mind—a determination to do better. Excellence has to be rooted in every aspect of a trust's operations. For example, quality must be the guiding force in every new service change.
The new duty of quality that the Health Bill imposes on London's health providers is, therefore, essential. Effective quality improvement processes must be in place in every hospital. Even where standards are good, we must


encourage management to ask how they can be improved further. We cannot have the management of even one London hospital looking at events in Bristol or Kent and saying, "They could never happen here, so we can just go on as we are."
In 1995, the National Audit Office first highlighted variations in NHS trusts' commitment to clinical audits, one form of quality control. In May last year, the medical press highlighted the continuing variations in that commitment. So it is clear that there is a need for a comprehensive quality programme to reinforce the new duty. The Commission for Health Improvement, able to monitor local clinical governance issues and the implementation of national health service frameworks across London, and to tackle persistent problems will help to drive forward such a quality programme.
Those measures are coupled with London's share of the £21 billion of new investment, and I praise my right hon. Friend the Secretary of State for providing £780,000 to modernise Northwick Park hospital's accident and emergency unit. All this will help to restore the belief of patients and carers that quality of care, not the financial bottom line, is the true raison d' etre of London's health service.
The merger of Northwick Park hospital with the Central Middlesex is an example of the new rationale. Two acute hospitals will continue their current levels of activity while merging into a single trust to release money from administration for patient care. Crucially, they will also bring together clinical teams to improve services and drive up standards of care.
London's health service has many near neighbours who, at different times, are better positioned to deliver health gain. Securing true partnership with the many arms of local authorities and with other statutory bodies whose primary purposes are, say, crime and disorder or poverty has been the aim of many health care reformers for 20 to 30 years. Only when the Health Bill becomes law will that wish begin to be fulfilled.
Together with the establishment of a Greater London Authority, a London development agency and the creation of a single London NHS region, important new opportunities are opening up for strategic health partnerships across London to tackle the health concerns of Londoners. London needs a health strategy to which the boroughs and other pan-London statutory bodies and stakeholders are committed. I welcome the NHS executive event that is planned soon to begin shaping the vision behind a London health strategy.
In my borough, a new spirit of partnership across the health care divide has begun to flower. Where once local hospital chief executives and council leaders would prowl warily around one another between routine confrontations about each proposed change in health care arrangements, the health White Paper and the granting of pilot status for best value to Harrow council have released wasted energy for more creative and innovative attempts to build genuine partnership, trust and understanding of the constraints and opportunities that confront local service providers and purchasers.
It would be wrong to suggest that everything in Harrow is sweetness and light, or that it will be so when the Health Bill becomes law. There is sustained enthusiasm, but there are questions too. General practitioners who felt ignored by

the local health authority and hospital managers who felt dragooned into fundholding have reservations about yet more change in their ways of working.
Hospital doctors, used to the destabilising change that was brought year after year by the perversities of the internal market, point to considerable challenges facing the health service. Even the most sceptical are engaging with and being engaged by other health and social care stakeholders, partly through the Harrow partnership, the vehicle for the council's best value pilot. Elections to the primary care group were strongly contested, and the west London NHS Direct bid was enthusiastically supported. Local hospitals are beginning to explore more effective ways of communicating with all GPs.
In Harrow, there is a sense of a service changing for the better, establishing effective partnerships and focusing on how best to allow existing excellence among local NHS and social care staff to develop. London needs more imaginative arrangements for providing and integrating services to raise the quality of care received by patients and their carers who, not surprisingly, are more concerned with totality of service than with whether part of a service is provided by an NHS trust or a local council.
London's health service learned important lessons about integrated care from the way in which winter pressures money had to be used. That money forced a much more rigorous approach to joint working around the discharge and rehabilitation planning for elderly people. We must continue that approach in the health improvement programmes, locking in local providers of London's health and social care to shared and accountable agendas for local health priorities.
When the Health Bill becomes law, the excuse for lack of proper joint working between health service and social services staff in London will be removed. The opportunity to blame legislation, or its interpretation by finance staff, will simply no longer exist.
The Health Bill, London's share of the £21 billion investment and the creation of a Greater London Authority mark the end of a new beginning for London's health service. The challenge will be to maintain the momentum.

Mr. Tony McNulty: I shall be brief, much to the pleasure of Opposition Front-Bench Members, not least the hon. Member for Orpington (Mr. Horam) who is now on his third party, I believe, in terms of representation in the House. It is a pity that the hon. Member for Rutland and Melton (Mr. Duncan) is not here. As he has done before, he called for a grown-up, serious, mature debate and then promptly descended into a childish, petulant, right-wing rant, which was of no value to anyone. He did the House a disservice by suggesting anything other than fact, which is that Edgware A and E facility stopped as a blue light function on 1 April 1997, not afterwards. I have the records and I can send him clear evidence that the health authority started the wind-down at the behest of the right hon. Member for Charnwood (Mr. Dorrell), or Loughborough as it then was, in February 1997, while his hon. Friends the then Members for Harrow, East, Mr. Dykes, and for Hendon, North, Sir John Gorst, were rallying round threatening to bring down the Government—and then, what a surprise, did not bother. It is a shame that the unique, innovative consultation process that followed, which included over 200 organisations and


gave the local community what they wanted in terms of a community hospital, is also pooh-poohed by Opposition Members.
I want to touch briefly on those issues that are not in Turnberg. A specific local one concerns the Royal National Orthopaedic hospital. It is the international orthopaedic facility in the world. It awaits still, some 10 years on in terms of the grinding wheels of health bureaucracy, a decision following the musculo-skeletal review in the area. I fully support the refurbishment and modernisation of this key international facility on the Stanmore site.
The one comment that I would endorse from the sixth form representative of Kingston—and on and on—and Surbiton (Mr. Davey) is that there are significant pockets of deep deprivation, which we miss at our peril, throughout outer London and suburban areas which often get overlooked because of the notion that, somehow, areas such as Harrow and Uxbridge are seas of affluence. We need to pick that up.
I am not one who indulges in luvvie behaviour. I do not subscribe to the school report that says that, no matter what they have done during their time in power since 1948, at heart, deep down the Conservatives really like the NHS. I do not believe that for a moment. I would not associate the hon. Member or right hon. Member for Macclesfield (Mr. Winterton)—I am not sure which—with this remark.

Mr. Nicholas Winterton: The hon. Member.

Mr. McNulty: It should be right hon. Member, not least for the real service he did in the House as a strong, independent Chairman of the Select Committee on Health. He is to be fully applauded for that; he deserves a gong for it if for nothing else. He certainly deserves one for the exceptional way in which he chaired the Greater London Authority Bill. At the risk of being mildly offensive, I would say that at best he is a semi-detached member, certainly of the last Government, if not of the Conservative party.
The luvvie behaviour stops here because the economic spokespersons for the Conservatives cannot say, as they have done, that they will freeze duty on fuel and tobacco. That impacts on London's NHS; the cash register rings £6 billion straight away. That is roughly a year's worth of the total £21 billion that we are putting into the health service. Where is that money going to come from? The Conservatives cannot, as some of them do, say that they now subscribe to the £40 billion, yet, at the same time, make all these other commitments elsewhere. They cannot do that and be credible to the public.
The Conservative Opposition are all over the place when it comes to the health service and, as ever, the Liberal Democrats are irrelevant. Unless hon. Members stand up and say that the hon. Member for Rutland and Melton is wrong to suggest charging people to visit GPs and to go to hospital, and to suggest getting more and more public money to subsidise further private medicine, they will be damned for ever as the enemies, not the friends, of the NHS—with the occasional honourable exception.

Mr. John Horam: For once, I am grateful to the Secretary of State because he has spared the House what Conservative Members call the Dobson rant: that is

a wholly partial diatribe about the mystical or mythical behaviour of the Conservatives during the past 30 years or so, buttressed by some partial facts and colourful epithets. On this occasion, he actually talked about the subject in hand, unlike his introduction of the Health Bill, when he barely considered the Bill. Today, he was rather more positive, although he gave us a rather partial and highly complacent view of the national health service in London.
It is my job to introduce a little reality to the debate. Although there are always some worthwhile things going on in the health service in London—I have no doubt about that—there is much that is not good from the point of view of our constituents and of patients. There is much that is actually deteriorating—for example, in relation to waiting lists. As we all know, waiting lists are one of the Government's central targets. However, formal waiting lists have gone up since the general election and have only now gone back to what they were at that time. In my area, Bromley has a most efficient national health service trust which does a good job for its patients—in referring to that I am being extremely fair to the Secretary of State-but even there the number of people on the waiting list is still more than 6,000, as it was at the general election.
That change is nothing like the 30 per cent. mentioned by the hon. Member for Ilford, South (Mr. Gapes) for his area; in fact, the change is less than 4 per cent. since the general election. The problem is that the number of people on the waiting list for the waiting list has increased; it has gone up by about 250,000 countrywide and has certainly increased substantially in Bromley. Furthermore, more operations are cancelled than previously; five operations a day have been routinely cancelled during the past few weeks. One day, more than 50 per cent. of operations were cancelled. Bromley used to take great pride in its operations service; it can no longer do so—not, of course, as a result of the actions of the consultants, the nurses and so on, who do the best they can, but because of the situation created by the Government.
The problem is not only the waiting times per se for ordinary surgery, but the fact that the waiting time for admission to a bed via the accident and emergency department is now the longest ever recorded in Bromley. As my hon. Friend the Member for Uxbridge (Mr. Randall) pointed out, in his notably fair-minded and humorous speech, that is one of the tests that we must consider—the number of people on the waiting list and the time it takes for them to be seen.
Last winter, the accident and emergency service was a disaster in Bromley; on 44 per cent. of days in December, January and February restrictions were placed on admissions to the A and E department. There were delays in admitting patients to the department on 80 per cent. of the days. I am sure that Labour Members are well aware that, in their own constituencies, there were figures similar to those for that efficient NHS service in Bromley.
There were some distressing cases; for example, an 87-year-old lady with cardiovascular problems had to wait more than 20 hours. I will not refer to such examples at length, because we are all familiar with such events. However, they should not occur; even the Bromley community health council—our local health watchdog—stated that such cases should not happen. However, last winter they happened in the NHS in London. Why did they happen? Some reasons are not under the control of the Government. I accept that winters vary in their


severity, and, accordingly, the demand on services is greater or less, and that last winter was not a particularly good one.
However, some things are under the Government's control—one of which is how they handle the money that they allocate to the NHS to deal with winter emergencies. For example, in the case of Bromley, the problem was made much worse because the money to deal with those winter pressures did not arrive until December. I ask hon. Members to imagine that. When does the Secretary of State think that winter starts? As a result, there was no possibility of real planning for the winter emergencies. How could one expect to recruit staff at a moment's notice to deal with acute problems when one did not know until December how much money would be received?
Those are the sort of problems that we had to face. The fact is that the Government were incompetent in the way that they handed out the money—never mind the amount, although that was too small, as the chairman of the health authority pointed out.
The subject of the London ambulance service was raised by my hon. Friend the Member for Rutland and Melton (Mr. Duncan), and I hope that the Minister will mention it when she winds up the debate. The great breakthrough in improving efficiency and performance and achieving targets came when ambulance services throughout the country achieved trust status. As a consequence of that, many ambulance services—Staffordshire, Essex and Kent, to name but a few—became excellent services, performing extremely well and meeting all their eight and 14-minute targets.
The London ambulance service has lagged behind, but, as a consequence of measures that the Conservative Government put in hand, its performance had been steadily improving, year after year. However, it has now collapsed all over again, and we read in the Evening Standard that only two out of five ambulances arrive within eight minutes—the target is being only 40 per cent. achieved. Why is that?

Mr. Dobson: It was 50 per cent., not 100 per cent., before.

Mr. Horam: Exactly—it was 50 per cent., but it has now gone down to 40 per cent., which is a deterioration of 10 per cent. under the Labour Government. Because of simple incompetence, the situation has deteriorated since Labour got into power. The story is the same in the London police service, and we now have fewer police in London. The fact is that, since Labour got into power, things have got worse in accident and emergency units, on waiting lists and in the ambulance service.
As London Members of Parliament, we all know how important primary care is and how dependent on it we are. Hon. Members on both sides will admit that the Conservative Government did a great deal to improve the quality and quantity of primary care in London. We disagree on the question of GP fundholding, but the right way to deal with what the Government perceive to be the problems arising from GP fundholding—that it may, in certain circumstances, increase the number of tiers in the health service or affect the way in which patients whose GPs are not fundholders are treated—is to make every GP a fundholder, not to level down and create large collectives that lead to increased bureaucracy. The

£150 million that the Government have spent creating that extra bureaucracy would have been far better spent on the front line of GP fundholding in London.
If we are honest, we have to acknowledge that there is much wrong in the health service in London. Some worthwhile things are happening, but the Government can only say of many of them that they were inherited from the Conservatives. The Labour Government inherited NHS Direct—a very good thing which we were working on before the general election. They inherited the private finance initiative—as has been pointed out, 31 of the 35 new hospitals being built are financed through the PFI.
The Labour Government have reaped where the Conservatives sowed—they had no ideas about the health service when they were in opposition, and they have none now. All too many of their ideas were started by the Conservatives and inherited by Labour, and there are fundamental problems that the Government are not tackling—they cannot even manage within existing constraints without displaying the sort of incompetence seen in Bromley last December. The only possible thing to say to someone who is ill is, "Do not be poor, do not be old, do not need expensive drugs, and do not live in London."

The Minister for Public Health (Ms Tessa Jowell): That is one of the more extraordinary speeches that we have heard from the Opposition Benches—perhaps it was caused by a bout of pre-election fever afflicting the hon. Member for Orpington (Mr. Horam).
Let me try to get back to the purpose of the debate, which is to give us an opportunity to set out the ways in which the Government have been setting about the process of modernising the national health service in London. Modernisation is about rebuilding the national health service: integrating health and social care, driving up standards of care, making the NHS more accessible, tackling health inequality and tackling the root causes of ill health.
We need to do that because London is a capital divided—a city of great extremes containing some of the richest and some of the poorest parts of the country. In my own inner-London constituency, one can pass from one area into another where life expectancy is up to eight years less, simply by crossing two roads, so short is the walk from affluence to poverty. The City—the financial centre of Europe—deals with billions of pounds every day. However, Newham in the east end of London, is the second most-deprived local authority in Britain. In fact, 13 of the poorest local authority areas in the country are in London.
London has more high earners earning —750 a week or more and more low earners earning —100 a week or less than anywhere else in the country. London is a city of contrasts. Inequality is the overarching theme that we considered in tackling London's health. That is why my right hon. Friend the Secretary of State commissioned the report by Sir Donald Acheson on inequality in health. That is why a centrepiece of our forthcoming health White Paper will be detailing the way in which we will meet our aim of improving the health of the poorest people in London and the rest of the country faster than we improve the health of the population overall. That will not be easy.
The chances of dying before the age of 75 are almost twice as high in some areas of east and south London—such as Newham, Tower Hamlets, Southwark and


Lambeth—as in the least-deprived parts of the capital, such as the City of London, Bromley and Kingston upon Thames. Infant mortality rates in inner-city London are some of the worst in Europe. Even some of the healthiest parts of London have higher infant mortality rates than the worst parts of Stockholm.
Those facts tell their own story. Hon. Members will be aware of other risk factors—for example, London has some of the lowest rates of immunisation and screening take-up. Those factors dictate our course of action in improving the health of Londoners, which is the purpose of modernising London's health service. My hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck) and several of my other hon. Friends referred to the importance of investing in primary care, particularly in order to reduce the number of isolated, single-handed practices. We must also address the problem of unequal access to care and the extent to which, for too many people, access does not necessarily match the need for care.
Modernisation means tackling those issues. As my right hon. Friend the Secretary of State set out, we are doing that by establishing health action zones, education action zones and sure start—which has been given the go-ahead in Camden, Haringey and Southwark, with much more of London to be covered in later announcements. They are the practical ways in which we will begin to remove the obstacles to the improved delivery of health care and improved health for Londoners.
If we look back at the previous Government's record, we will see that nothing crystallises their folly more than what they did to London's hospitals—particularly their mad claim, which proved to be disastrously wrong, that London had too many acute beds. The Turnberg report compared the situation in London with that in the rest of the country and concluded that London did not have more beds than it needed. We are determined that the number of beds should be based on a rational assessment of need, which is why, last September, my right hon. Friend the Secretary of State announced a national bed inquiry to ensure that in London, as well as the rest of the country, the national health service is equipped with the resources and beds to meet the demands of patient care.

Mr. Wilkinson: Will the right hon. Lady give way?

Ms Jowell: No. I am very short of time and I have cut short the winding-up speech so that I can respond to the debate.
This debate is an opportunity to report on progress in implementing the Turnberg recommendations, all of which we accepted, which will take 10 years. The report calls for action and investment in primary care, mental health, intermediate care and community services. In the judgment of the Turnberg panel, none of those services was up to the standard that the people of London had a right to expect. My hon. Friends the Members for Eltham (Mr. Efford), for Upminster (Mr. Darvill) and for Wimbledon (Mr. Casale) all expressed concerns about that.
I say to the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), who asked about action on delayed discharge, that we shall consult in the summer on guidance for the approach to that problem, so that we can take practical measures to tackle it.
The Turnberg panel did a remarkable job and we are grateful to it. However, we must be clear that putting those recommendations into practice will take the next 10 years.
Modernisation of capital investment in London is critical. At least 50 primary care premises will be improved this year, benefiting around 100,000 patients. In the biggest hospital building programme in London, £billion will be spent on new and improved modern hospitals. My hon. Friends the Members for Hornchurch (Mr. Cryer), for Ilford, South (Mr. Gapes), for Upminster and for Romford (Mrs. Gordon) referred to the Oldchurch hospital, which is being considered by Ministers.
Modernisation schemes are planned or under way at 32 of London's accident and emergency departments, and improvements include new ventilators, cardiac monitors and anaesthetic units at the Royal Free hospital, a new X-ray room at Kingston hospital and an admissions ward at Epsom general. Whipps Cross hospital, which had problems last winter, had some of the most rundown facilities, and the trust is to be allocated £695,000 from the capital modernisation fund to enable it to make improvements in the flow of patients through the accident and emergency department by redesigning ambulance arrivals and resuscitation areas.
Several hon. Members expressed concern about the London ambulance service. Of course we share their concern about its performance. The service's problems have been exacerbated by absenteeism and staff shortages, but it is responding to more calls than ever. The London regional office will be working closely with the London ambulance service to ensure that its standards are those that have been promised.
We have made fantastic progress in tackling waiting lists. To hear the Opposition try to rewrite the facts is, frankly, extraordinary. The creation of a Greater London Authority and a mayor for London gives us the opportunity to charge the mayor with the major responsibility of safeguarding Londoners' health.
We have heard the usual litany from the Opposition today—they have talked down the national health service and its sustainability. They are a party in desperate search of a policy.

It being Seven o'clock, the motion for the Adjournment of the House lapsed, without Question put.

MEMBERS' TRAVEL (NATIONAL PARLIAMENTS AND EUROPEAN UNION INSTITUTIONS)

Motion made,
That the Resolution of 6th December 1991 relating to travel by Members to European Community Institutions be rescinded.
That, in the opinion of this House, provision should be made as from 1st April 1999 for reimbursing Members in respect of the cost of travelling on parliamentary duties between the United Kingdom and any European Union institution in Brussels, Luxembourg or Strasbourg or the national parliament of another European Union member state and any additional expenses necessarily incurred in such travelling, subject to the limit that

(1) the amount payable to a Member in any year, beginning with 1st April, shall not exceed the aggregate of—

(a) the cost of a return business class airfare for the journey on the assumption that the journey begins and ends at a London airport and that the destination is any of the


three cities mentioned above or the location of the national parliament of a European Union member state; and
(b) twice the corresponding civil service class A standard subsistence rate for the time being in operation; and

(2) expenditure in pursuance of this Resolution within financial year 1999–2000 shall not exceed the total currently planned for expenditure on travel by Members to European Union institutions within that year.—[Mr. Allen.]

Hon. Members: Object.

Trainee Obstetricians

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Allen.]

7 pm

Dr. Evan Harris: We are heading towards making redundant a number of ready-to-be consultants, which the national health service desperately needs and who have cost the country a fortune to train. I shall set out the figures involved, then describe the demand for consultants and consider some of the problems meeting that demand and some of the potential solutions to both the immediate crisis and long-term work force planning problems.
In a written answer from the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), which I received today, I was told that there are 117 specialist registrars in obstetrics and gynaecology who hold national training numbers, NTNs, and are therefore eligible to take up consultant posts and who have obtained their certificate of completion of specialist training, CCST, but for whom there are no consultant posts available. Of those 117, 86 had been in that position for more than six months.
Similarly, it was reported in January that 112 specialist registrars holding NTNs and with CCSTs had no consultant posts to go to, of whom 23 completed their training 18 months earlier. It was envisaged then that 82 more people would be in such a position by March 1999, of whom only a few would be mopped up by newly established consultant posts and the filling of consultant vacancies from retirement and death.
The number of new CCST holders who will complete specialist training in 1999–2000 and 2000–01 has been estimated to be 188 and 122 respectively. Similarly, Department of Health figures for the next three calendar years, are 137, 185 and 100 respectively. Either way, that makes for about 500 trainees with NTNs who are eligible to be consultants and waiting for posts, on whom this country has spent a great deal of money. At the current rate of consultant vacancies and establishment of new posts, such people will mostly have to be made redundant or find other sources of income. That is clearly unsatisfactory.
According to another written answer, it costs £160,000 just to put a medical student through medical school. The cost of training a doctor up to CCST level in obstetrics and gynaecology can be estimated by adding up the element of their salary that is paid for annually through the medical and dental education levy—generally half the basic salary, except in the house officer year, when it is 100 per cent. of the basic salary. Even a quick calculation suggests that an average general and specialist training period of about 10 years costs at least another —150,000—making a grand total of about one third of a million pounds per doctor, for many of whom there will be no consultant post.
It has already been made clear to me by individuals that they will not be hanging around waiting to be sacked when the 18-month stay of execution runs out on those with certificates of completion of specialist training. They will be moving abroad or into other jobs. I have heard of one trainee who plans to become an air hostess because she cannot bear waiting around with no likely career progression.


There is a desperate need for more consultant posts in this country. Let me make clear the current planned rate of expansion. The Department of Health has indicated that about 50 consultant appointments were made in the past year. My understanding is that about half those were vacancies through retirement and other causes and about half were newly established posts. At that rate, about 350 of the 500 trainees with CCSTs who will be eligible to become consultants over the next three years will have no posts to go to. It is a problem of degree of magnitude, not something that can be improved quickly or without the radical action that I will be urging on the Government.
This country is in desperate need of additional consultants, particularly in our obstetric units. The fourth and fifth reports of the confidential enquiry into stillbirths and deaths in infancy have indicated that about 80 per cent. of intra-partum deaths—deaths during labour—that were identified for the study, were criticised for sub-optimal care because alternative management would reasonably have been expected to make a difference to the outcome in about half the cases and might have helped in another quarter.
The confidential inquiry into maternal deaths from 1991 to 1993 raised concerns even then about a possible lack of senior obstetric consultant input into the care of critically ill women. It drew attention to inappropriate standards of care due to inappropriate delegation of responsibility for clinical management to relatively inexperienced junior doctors. The evidence from confidential inquiries shows that we are letting down the women of this country in the quality of service we are providing.
In addition, the confidential inquiry into perioperative deaths, which impacts on gynaecological emergencies as well as operative obstetric emergencies, indicated that direct consultant involvement in emergency surgery, particularly out of hours, may have led to an improved outcome for many patients. That is now accepted wisdom and best practice in the health service.
The Minister will be aware of the cost to the health service of clinical negligence in obstetrics. It dwarfs the cost of clinical negligence and litigation in other specialties. The clinical negligence scheme for trusts has identified the importance of consultant input in the labour ward and suggested that a standard of at least 40 hours of consultant sessions on the labour ward during the working week is desirable. That was backed recently by the joint report of the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives which, for the first time, have come together to endorse clear recommendations for consultant expansion, among a range of other suggestions.
There is a need to expand the number of consultants to improve the quality of care for women and to reduce the enormous costs of litigation as a result of inappropriate care, perhaps because of inappropriate levels of experience among the doctors concerned.
According to figures I have seen, which are not disputed, only 28 new posts were established in 1998, as opposed to vacancies, of which only a similar number were filled. Yet there were 37 appointments of non-consultant career grade doctors in 1998 alone. There is no way that the Government will be able to direct the

consultant expansion we need while there is a free-for-all in medical work force planning. Answers that the Government have given to me show that they accept that it is still a free-for-all for trusts. They say that it is for NHS trusts to decide the number and grades of staff they need. That is a free market in staff. It does not allow the Government easily, if at all, to implement their policies in terms of quality and of reducing litigation costs to trusts which are, for better or worse, concerned with making the books balance in the short term.
We have an immediate problem, and various solutions have been proposed. One solution is for those doctors to continue occupying specialist registrar posts; but that will not do. They would either block slots for new trainees, or impose an extra cost on the national health service as their slots were filled by newer trainees. Therefore, additional money should not be spent on prolonging their tenure in those posts, and any available money should be invested in ensuring quality and in solving the problem once and for all. Regardless, keeping those doctors on in those posts for much longer would continue to deprive future consultants of those training opportunities.
Another proposal is to do nothing or to fiddle about with pilot schemes, which—judging by a letter of 28 April from Mr. Hugh Taylor, the NHS director of personnel—the Department of Health currently seems to favour. The letter quite accurately describes the current stark situation, and makes no bones about the crisis engulfing medical work force planning. It is not satisfactory to wait. Staff will leave, and quality and care will not improve without direct investment in consultant posts. Regardless, it simply will not be possible to remove junior doctors, as envisaged in the letter.
The letter proposes that temporary non-consultant posts should be created for a further 12 months. Therefore, by definition, the posts—unless they are a continuation of training posts, in which case one wonders from where the funding will come—will be non-consultant career grade. It would not be possible for the health service to remove doctor posts, at either senior house officer or specialist level, by entirely eliminating slots or by not filling specialist registrar slots with visiting trainees, who are critically necessary to cover out-of-hours work rotas. Without them, the junior doctors hours initiative—which, this week, has featured so prominently in the media—will be under further pressure.
Perhaps the Government intend that the proposed 12-month extensions for doctors—who are ready to be consultants—should involve on-call duties with junior doctors filling the posts they are seeking to leave. I have heard a rumour, from the Trent region, that a doctor was promised a post in which he would receive 50 per cent. pay—the standard on-call overtime rate—but would not be paid for daytime work. Doctors would therefore be allowed to use NHS research facilities, but would not be able to make their mortgage payments.
The Government's proposals that I have seen would not be effective. Perhaps the Government are seriously considering trying to tempt trainees into some type of non-consultant career grade post—such as the 12-month temporary extension—but such a post would clearly be a blight on a trainee's curriculum vitae. They would not be a popular option. It is also not clear how the posts would be paid for. If no extra money is provided, and training slots are left as they are, the new posts will impose an extra cost. It would also not be satisfactory to seek to


remove medical and dental education levy funding to pay for posts in other specialties. However, if extensions are required but there is no additional Government funding, that funding will have to be used.
None of those solutions is a real option. The only solution is a centrally funded expansion of consultant posts. It would cater, in waiting list initiative cases, for improved training, supervision and service; for increased cover on obstetrics wards; for decreased litigation and litigation costs; and, by investing in adequate senior medical cover, for insuring against problems in recruiting senior nurses and midwives. That is the solution, and it would be true modernisation of the health service. If the Government would only use some of their funds to fund those posts, it would solve all the problems that I have described. Moreover, it is the action that has been called for by the British Medical Association and the Royal College of Obstetricians and Gynaecologists.
The joint report which I referred to earlier called for 24-hour consultant cover on big obstetric units and 40-hour a week consultant cover with no other clinical duties on obstetric wards during the working day. That implies an increase of around 300 in the number of consultants. That is the number needed to deal with the problem in the short term.
However, there are also longer-term issues. We must try to prevent the problem from arising again and secure the consultant expansion that the health service needs to provide a consultant-based service. The solution is clearly to restore manpower controls and end the free-for-all. There should be a limit to staff grade appointments back to 10 per cent. of the consultant work force, which would give incentives for trusts to expand their numbers of consultants rather than the non-consultant career grades. Associate specialists should once again become personal appointments, not advertised as additional non-consultant career grade posts. We should create paths back to training for those in non-consultant career grades who have been lured into those posts for lack of consultant opportunities.
We should ban the creation of illegal SHOs with no staffing or training approval. It is outrageous that doctors are led into applying for those posts when they hold no training or staffing approval because there is inadequate training in the posts. We should ban the use of non-standardised posts, which lead to poor-quality care and confuse patients. If a patient sees the word "specialist", they assume that the person is a consultant. That is the European term and the term that the Government use. Instead, trusts have created trust specialists and trust grade doctors willy-nilly as a short-term, cheap, expedient way of getting through service work of a lower quality than that which consultants offer.
I accept that planning is difficult. Having too many junior doctors causes this sort of problem, while having too few can hold back the consultant expansion that could develop the specialty. The answer is clearly to have more central control of manpower resources. I speak from experience, having served on the central manpower committee, which is a joint committee of the profession, and having worked in the area for three years.
The final aspect of my solution is to give 100 per cent. of the basic salary of trainees to deans to use within the medical and dental education levy. That would be a

powerful tool for ensuring that trusts were rewarded for consultant expansion by attracting new specialist registrar slots and would give some protection of training for juniors against the exigencies of the service. I sincerely ask the Minister to take action to solve the acute immediate problem and to take on responsibility for the long-term solution. We have a duty to women and we must not scrimp in quality care. We have a duty to trainees and we must not waste doctors.

The Minister for Public Health (Ms Tessa Jowell): I have listened with great interest to the points raised by the hon. Member for Oxford, West and Abingdon (Dr. Harris). He is right to say that there is a serious mismatch between the number of fully trained specialists in obstetrics and gynaecology and the number of consultant jobs available. We are rightly concerned about that.
I should like to set out the background. By the end of April, there were 117 doctors who had completed their specialist training in obstetrics and gynaecology but had not found suitable posts. We expect that, over the next three years, the number of specialists completing their training will be 137, 185 and 100 respectively. Between 1992 and 1997, consultant expansion in the specialty grew by around 4.5 per cent. a year. To absorb all those doctors completing their training into consultant posts over the next three years the consultant expansion will have to increase to approximately 10 per cent. a year.
This difficult and complex situation needs to be handled sensitively and carefully. There has clearly been a failure to appreciate fully the supply and demand position for the specialty and in particular the pace of change in relation to consultant expansion.
We have already acknowledged the need to look more closely at work force planning processes—locally, regionally and nationally—so as to ensure a better match in the future between those trained and the jobs available in all specialties and professions. We will be undertaking work over the next few months with that in mind.
In the short term, we accept the need to deal with the immediate problem of career prospects for those currently training in obstetrics and gynaecology, including the current surplus of fully trained higher specialists. For that reason, we set up a small working group last autumn including representatives from the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the joint consultants committee, the junior doctors committee and NHS management. The group reviewed the position and proposed a way forward.
The working group recognised that there were strong arguments on quality grounds—to which the hon. Gentleman referred—for balancing an increased emphasis on midwifery-led services with access to the best-quality medical advice and expertise to deal with emergencies and difficulties. It noted that, in practice, the ratio of consultants to juniors was lower in obstetrics than in most other specialties. It also expressed concern about the numbers of appointments that were continuing to be made to non-consultant career grade posts.
The working group noted the joint report from the RCOG and RCM, "Setting Standards for improving Women's Health; Safer Childbirth", which dealt specifically with staffing and organisational issues. The


report recommended greater consultant cover on labour wards in all but the smallest obstetric units. The RCOG has sent a copy to all NHS chief executives. The group also considered another report from the joint consultants committee which discussed issues about consultants' job plans in obstetrics and gynaecology. The JCC proposed changes to consultants' working patterns in future to provide for a consultant-based service.
The working group agreed that a combination of short, medium and long-term action was needed to address the situation. In the short term, it was agreed that it was imperative to engage the NHS in discussions about staffing and grade mix in obstetrics and gynaecology.
My officials have taken action to ensure that that happens quickly. A series of workshops is about to be arranged by each regional office to address that specific issue. They will not only look at the urgent and immediate problems of current surplus specialists without appointments, but address issues connected with those currently in specialist training and their career prospects. It is important not only to look at our current problems, but to consider the numbers in training.
We want two main outcomes from the workshops: first, to discover ways to find employment quickly for current surplus holders of the certificate of completion of specialist training, and in so doing improve the quality of current obstetric services, and secondly, to secure agreement from a number of trusts to act as pilot sites to evaluate different ways of working and staffing profiles which have less reliance on juniors and more input from qualified staff—midwives and fully qualified specialists.
My officials met representatives of each regional office at the end of April, and workshops are now being set up. We expect the first one to take place in July, probably in the west midlands. In the workshops, we will be working jointly with the profession, as was agreed by the working group.

Dr. Harris: The Minister is hinting at consultant-only units with no junior doctors; something that has been suggested in other specialties, including by researchers in my area in Oxford. However, that will cost money, as it will take a lot of consultants to give that on-call cover. Will there be new funding as part of the short-term and long-term solution?

Ms Jowell: I am setting out the stages by which we intend to address the problem. The first stage is to engage in joint discussions with the colleges, the working group and the NHS to address the short-term problem in the context of the need for clarity about the long-term position.
In the meantime, there will be continuing local action aimed at discussion with the postgraduate medical deans, who are continuing to extend the training period of all newly qualified specialists for as long as 18 months to give them time to secure a post. They will also continue to offer advice and help to all specialist trainees in obstetrics and gynaecology, and give particular support to CCST holders experiencing difficulties in securing a post.
Postgraduate deans will also explore ideas and opportunities aimed at improving the career prospects of all specialist trainees in obstetrics and gynaecology, including the feasibility of switching to another specialty where career prospects are better. I understand that the

RCOG is having discussions with the Royal College of Surgeons to consider the feasibility of whether specialist trainees could, at an early stage of training, switch to a surgical specialty. Similar discussions with the Royal College of General Practitioners will also be held. We are fully supportive of the RCOG in its efforts to find solutions in this way. We want to work with the college and support it.
We are encouraging regional directors—through local workshops, and action by deans, consortiums or local medical work force advisory groups—to persuade trusts to offer temporary appointments of 12 months to CCST holders on fixed-term contracts. Such posts would be distinct from career-grade posts, and would be open to competition. Essentially, these would be developmental posts, with particular emphasis on new ways of working; possibly in the context of the pilot studies that I have already mentioned.
As I have said, the problem of surplus specialists in this specialty is multi-factorial and complex. Equally, solutions likely to improve the career prospects of those currently engaged in specialist training, or those who have recently completed training, are likely to vary. Such solutions will be thoroughly explored with local NHS management, by the profession and by my officials, as appropriate.
We have already taken steps this year to reduce higher specialist training opportunities in this specialty to ease the situation. In the light of advice from the specialist work force advisory group, which considers future investment in training across all medical specialties, we have reduced training opportunities by 76 places during this year. This will have the effect of restricting entry to the specialty to 65 places nationally. This decision was taken to avoid the detrimental effect of closing entry to the specialty altogether, given the knock-on effect that that would have on senior house officers and their career intentions.

Dr. Harris: Before she finishes, can the Minister guarantee that none of these doctors—who have cost us at least £300,000 to train—will be made redundant this year? Will she address the question of bringing back manpower controls?

Ms Jowell: Every possible effort will be made to ensure that those 117 people are found jobs. That cannot be a guarantee, but I have set out the steps that the Department intends to take to address a completely unacceptable situation. The remedy lies in immediate action—which we are taking—and a sustained, long-term assessment of the need for consultant posts and the deployment of consultant posts in the specialty.
The issues throw into sharp relief the difficulties associated with work force planning. In some respects, there have been improvements in recent years—for example, in addressing shortages in specialities such as anaesthetics and accident and emergency—but minimising shortages or over-supply remains a difficult balancing act. We must look carefully at our approach to planning—

The motion having been made at Seven o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at half-past Seven o'clock.